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

•Prospective cohort study of risk factors for VAP over 18 years in 9 Asian countries.•Male gender, age, public and private hospitals increase the risk of VAP.•Medical-Surgical, neurologic, and medical ICUs showed the highest risk for VAP.•Device utilization and length of stay increase significantly...

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Vydáno v:American journal of infection control Ročník 51; číslo 7; s. 751 - 757
Hlavní autoři: Rosenthal, Victor Daniel, Yin, Ruijie, Rodrigues, Camilla, Myatra, Sheila Nainan, Divatia, Jigeeshu Vasishth, Biswas, Sanjay K, Shrivastava, Anjana Mahesh, Kharbanda, Mohit, Nag, Bikas, Mehta, Yatin, Sarma, Smita, Todi, Subhash Kumar, Bhattacharyya, Mahuya, Bhakta, Arpita, Gan, Chin Seng, Low, Michelle Siu Yee, Kushairi, Marissa Bt Madzlan, Chuah, Soo Lin, Wang, Qi Yuee, Chawla, Rajesh, Jain, Aakanksha Chawla, Kansal, Sudha, Bali, Roseleen Kaur, Arjun, Rajalakshmi, Davaadagva, Narangarav, Bat-Erdene, Batsuren, Begzjav, Tsolmon, Basri, Mat Nor Mohd, Tai, Chian-Wern, Lee, Pei-Chuen, Tang, Swee-Fong, Sandhu, Kavita, Badyal, Binesh, Arora, Ankush, Sengupta, Deep, Tao, Lili, Jin, Zhilin
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.07.2023
Témata:
Infectious Disease
Intensive care unit
International nosocomial infection control consortium
Limited resources countries
Low and middle income countries
Nosocomial pneumonia
International nosocomial infection control consortium
Limited resources countries
Nosocomial pneumonia
Intensive care unit
Low and middle income countries
ISSN:0196-6553, 1527-3296, 1527-3296
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Abstract •Prospective cohort study of risk factors for VAP over 18 years in 9 Asian countries.•Male gender, age, public and private hospitals increase the risk of VAP.•Medical-Surgical, neurologic, and medical ICUs showed the highest risk for VAP.•Device utilization and length of stay increase significantly the risk of VAP.•It is recommended limiting use of tracheostomy. 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.
AbstractList Highlights•Prospective cohort study of risk factors for VAP over 18 years in 9 Asian countries. •Male gender, age, public and private hospitals increase the risk of VAP. •Medical-Surgical, neurologic, and medical ICUs showed the highest risk for VAP. •Device utilization and length of stay increase significantly the risk of VAP. •It is recommended limiting use of tracheostomy.
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.BACKGROUNDVentilator 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).METHODSWe 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.RESULTS153,717 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.CONCLUSIONSSome 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.
•Prospective cohort study of risk factors for VAP over 18 years in 9 Asian countries.•Male gender, age, public and private hospitals increase the risk of VAP.•Medical-Surgical, neurologic, and medical ICUs showed the highest risk for VAP.•Device utilization and length of stay increase significantly the risk of VAP.•It is recommended limiting use of tracheostomy. 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.
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.
Author Tang, Swee-Fong
Yin, Ruijie
Sengupta, Deep
Chawla, Rajesh
Nag, Bikas
Tao, Lili
Myatra, Sheila Nainan
Rosenthal, Victor Daniel
Sarma, Smita
Basri, Mat Nor Mohd
Bhattacharyya, Mahuya
Bhakta, Arpita
Wang, Qi Yuee
Bali, Roseleen Kaur
Rodrigues, Camilla
Gan, Chin Seng
Mehta, Yatin
Kansal, Sudha
Begzjav, Tsolmon
Kharbanda, Mohit
Low, Michelle Siu Yee
Arjun, Rajalakshmi
Badyal, Binesh
Chuah, Soo Lin
Sandhu, Kavita
Jin, Zhilin
Bat-Erdene, Batsuren
Todi, Subhash Kumar
Tai, Chian-Wern
Biswas, Sanjay K
Lee, Pei-Chuen
Divatia, Jigeeshu Vasishth
Shrivastava, Anjana Mahesh
Jain, Aakanksha Chawla
Kushairi, Marissa Bt Madzlan
Davaadagva, Narangarav
Arora, Ankush
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  organization: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
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CitedBy_id crossref_primary_10_54033_cadpedv22n8_018
crossref_primary_10_1016_j_jcrc_2023_154500
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ContentType Journal Article
Copyright 2022 Association for Professionals in Infection Control and Epidemiology, Inc.
Association for Professionals in Infection Control and Epidemiology, Inc.
Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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– notice: Association for Professionals in Infection Control and Epidemiology, Inc.
– notice: Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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ISSN 0196-6553
1527-3296
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IsPeerReviewed true
IsScholarly true
Issue 7
Keywords International nosocomial infection control consortium
Limited resources countries
Nosocomial pneumonia
Intensive care unit
Low and middle income countries
Language English
License Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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Snippet •Prospective cohort study of risk factors for VAP over 18 years in 9 Asian countries.•Male gender, age, public and private hospitals increase the risk of...
Highlights•Prospective cohort study of risk factors for VAP over 18 years in 9 Asian countries. •Male gender, age, public and private hospitals increase the...
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...
Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk...
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SubjectTerms Infectious Disease
Intensive care unit
International nosocomial infection control consortium
Limited resources countries
Low and middle income countries
Nosocomial pneumonia
Title Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings
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https://www.clinicalkey.es/playcontent/1-s2.0-S0196655322008057
https://dx.doi.org/10.1016/j.ajic.2022.11.005
https://www.ncbi.nlm.nih.gov/pubmed/36400318
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