Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

Autor: Victor Daniel Rosenthal, Ruijie Yin, Camilla Rodrigues, Sheila Nainan Myatra, Jigeeshu Vasishth Divatia, Sanjay K Biswas, Anjana Mahesh Shrivastava, Mohit Kharbanda, Bikas Nag, Yatin Mehta, Smita Sarma, Subhash Kumar Todi, Mahuya Bhattacharyya, Arpita Bhakta, Chin Seng Gan, Michelle Siu Yee Low, Marissa Bt Madzlan Kushairi, Soo Lin Chuah, Qi Yuee Wang, Rajesh Chawla, Aakanksha Chawla Jain, Sudha Kansal, Roseleen Kaur Bali, Rajalakshmi Arjun, Narangarav Davaadagva, Batsuren Bat-Erdene, Tsolmon Begzjav, Mat Nor Mohd Basri, Chian-Wern Tai, Pei-Chuen Lee, Swee-Fong Tang, Kavita Sandhu, Binesh Badyal, Ankush Arora, Deep Sengupta, Lili Tao, Zhilin Jin
Rok vydání: 2022
Předmět:
Zdroj: American Journal of Infection Control.
ISSN: 0196-6553
DOI: 10.1016/j.ajic.2022.11.005
Popis: Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p.0001); public (OR=1.84; 95%CI=1.49-2.26, P.0001), and private (OR=1.57; 95%CI=1.29-1.91, P.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P.0001) showed the highest risk.Some identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.
Databáze: OpenAIRE
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