ROSENTHAL, VICTOR DANIEL and Jin, Zhilin and Memish, Ziad A. and Rodrigues, Camilla Rodrigues and Myatra, Sheila Nainan and Kharbanda, Mohit and Valderrama-Beltran, Sandra Liliana and Mehta, Yatin and Daboor, Mohammad Abdellatif and Todi, Subhash Kumar and Aguirre-Avalos, Guadalupe and Guclu, Ertugrul and Gan, Chin Seng and Alvarez, Luisa Fernanda Jiménez and Chawla, Rajesh and Hlinkova, Sona and Arjun, Rajalakshmi and Agha, Hala Mounir and Chavarria, Maria Adelia Zuniga and Davaadagva, Narangarav and Mat Nor, Mohd Basri and Gomez, Katherine and Moros, Daisy Aguilar De and Tai, Chian-Wern and Gonzalez, Alejandro Sassoe and Moreno, Lina Alejandra Aguilar and Sandhu, Kavita and Janc, Jarosław and Bocanegra, Mary Cruz Aleman and Yildizdas, Dincer and Medina, Yuliana Andrea Cano and Mota, Maria Isabel Villegas and Omar, Abeer Aly and Duszynska, Wieslawa and BelKebir, Souad and El-Kholy, Amani Ali and Alkhawaja, Safaa Abdulaziz and Florin, George Horhat and Medeiros, Eduardo Alexandrino and Tao, Lili and Tumu, Nellie and Elanbya, May Gamar and Dongol, Reshma and Mioljević, Vesna and Raka, Lul and Dueñas, Lourdes and Carreazo, Nilton Yhuri and Dendane, Tarek and Ikram, Aamer and Kanj, Souha S. and Petrov, Michael M. and Bouziri, Asma and Hung, Nguyen Viet and Belskiy, Vladislav and Elahi, Naheed and Bovera, María Marcela and Yin, Ruijie
(2023)
Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC).
Antimicrobial Stewardship & Healthcare Epidemiology, 3 (1).
pp. 1-10.
ISSN 2735-4977
E-ISSN 2735-4985
Abstract
Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those ofhigh-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs.Design: Prospective cohort study.Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and MiddleEastern countries.Participants: The study included patients admitted to ICUs across 24 years.Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent var-iables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidenceinterval [CI], 1.16–1.28; P<.0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P<.0001);mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23–1.31; P<.0001); continuous positive airway pressure (CPAP), whichwas associated with the highest risk (aOR, 13.38; 95% CI, 11.57–15.48; P<.0001); tracheostomy connected to a MV, which was associated withthe next-highest risk (aOR, 8.31; 95% CI, 7.21–9.58; P<.0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34–7.21;P<.0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17–1.29; P<.0001); admission to a public hospital (aOR, 1.59; 95% CI,1.35-1.86; P<.0001); middle-income country (aOR, 1.22; 95% CI, 15–1.29; P<.0001); admission to an adult-oncology ICU, which wasassociated with the highest risk (aOR, 4.05; 95% CI, 3.22–5.09; P<.0001), admission to a neurologic ICU, which was associated withthe next-highest risk (aOR, 2.48; 95% CI, 1.78–3.45; P<.0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79–3.07;P<.0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51–0.77; P<.0001).Conclusions: Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country incomelevel. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use andimplementing a set of evidence-based VAP prevention recommendations.
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