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)

被引：13

作者：

Rosenthal, Victor Daniel ^{[1
,2
]}

Jin, Zhilin ^{[1
]}

Memish, Ziad A. ^{[3
]}

Rodrigues, Camilla ^{[4
]}

Myatra, Sheila Nainan ^{[5
]}

Kharbanda, Mohit ^{[6
]}

Valderrama-Beltran, Sandra Liliana ^{[7
]}

Mehta, Yatin ^{[8
]}

Daboor, Mohammad Abdellatif ^{[9
]}

Todi, Subhash Kumar ^{[10
]}

Aguirre-Avalos, Guadalupe ^{[11
]}

Guclu, Ertugrul ^{[12
]}

Gan, Chin Seng ^{[13
]}

Alvarez, Luisa Fernanda Jimenez ^{[14
]}

Chawla, Rajesh ^{[15
]}

Hlinkova, Sona ^{[16
]}

Arjun, Rajalakshmi ^{[17
]}

Agha, Hala Mounir ^{[18
]}

Chavarria, Maria Adelia Zuniga ^{[19
]}

Davaadagva, Narangarav ^{[20
]}

Basri, Mat Nor Mohd ^{[21
]}

Gomez, Katherine ^{[22
]}

De Moros, Daisy Aguilar ^{[23
]}

Tai, Chian-Wern ^{[24
]}

Gonzalez, Alejandro Sassoe ^{[25
]}

Moreno, Lina Alejandra Aguilar ^{[26
]}

Sandhu, Kavita ^{[27
]}

Janc, Jaroslaw ^{[28
]}

Bocanegra, Mary Cruz Aleman ^{[29
]}

Yildizdas, Dincer ^{[30
]}

Medina, Yuliana Andrea Cano ^{[31
]}

Mota, Maria Isabel Villegas ^{[32
]}

Omar, Abeer Aly ^{[33
]}

Duszynska, Wieslawa ^{[34
]}

Belkebir, Souad ^{[35
]}

El-Kholy, Amani Ali ^{[36
]}

Alkhawaja, Safaa Abdulaziz ^{[37
]}

Florin, George Horhat ^{[38
]}

Medeiros, Eduardo Alexandrino ^{[39
]}

Tao, Lili ^{[40
]}

Tumu, Nellie ^{[41
]}

Elanbya, May Gamar ^{[42
]}

Dongol, Reshma ^{[43
]}

Mioljevic, Vesna ^{[44
]}

Raka, Lul ^{[45
]}

Duenas, Lourdes ^{[46
]}

Carreazo, Nilton Yhuri ^{[47
]}

Dendane, Tarek ^{[48
]}

Ikram, Aamer ^{[49
]}

Kanj, Souha S. ^{[50
]}

机构：

[1] Univ Miami, Miller Sch Med, Dept Publ Hlth Sci, 1120 NW 14th St. Floor 9,Office 912, Miami, FL 33136 USA

[2] Int Nosocomial Infect Control Consortium INICC Fdn, Miami, FL USA

[3] Minist Hlth, King Saud Med City, Riyadh, Saudi Arabia

[4] Pd Hinduja Natl Hosp & Med Res Ctr, Mumbai, India

[5] Tata Mem Hosp, Homi Bhabha Nacl Inst, Mumbai, India

[6] Desun Hosp, Kolkata, India

[7] Univ San Ignacio, Pontificia Univ Javeriana Hosp, Bogota, Colombia

[8] Medanta, Gurgaon, India

[9] King Hussein Canc Ctr, Amman, Jordan

[10] Adv Medicare Res Inst AMRI Hosp, Kolkata, India

[11] Univ Guadalajara, Ctr Univ Cienciasde Salud, Hosp Civil Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico

[12] Sakarya Univ, Training & Res Hosp, Sakarya, Turkiye

[13] Univ Malaya, Med Ctr, Kuala Lumpur, Malaysia

[14] Clin Univ Colombia, Bogota, Colombia

[15] Indraprastha Apollo Hosp, New Delhi, India

[16] Catholic Univ Ruzomberok, Cent Mil Hosp Ruzomberok, Fac Hlth, Ruzomberok, Slovakia

[17] Kerala Inst Med Sci & Hlth, Trivandrum, India

[18] Cairo Univ, Specialized Pediat Hosp, Cairo, Egypt

[19] Hosp Clin Bibl San Jose de Costa Rica, San Jose de Costa Rica, Costa Rica

[20] Intermed Hosp, Ulaanbaatar, Mongolia

[21] Int Islamic Univ Malaysia, Kuantan, Pahang, Malaysia

[22] Clin Sebastian Belalcazar, Cali, Colombia

[23] Hosp Nino Dr Jose Renan Esquivel, Panama City, Panama

[24] Univ Kebangsaan Malaysia, Specialist Childrens Hosp, Kuala Lumpur 56000, Malaysia

[25] Hosp Reg Alta Especial Ixtapaluca, Ixtapaluca, Mexico

[26] Clin Infantil Santa Maria Lago, Bogota, Colombia

[27] Max Super Specialty Hosp Saket Delhi, New Delhi, India

[28] 4th Clin Mil Hosp Polyclin, Dept Anesthesiol & Intens Therapy, Wroclaw, Poland

[29] Hosp San Jose TecSalud, Monterrey, Nuevo Leon, Mexico

[30] Cukurova Univ, Balcali Hosp, Adana, Turkiye

[31] Inst Corazon Bucaramanga Sede Bogota, Bogota, Colombia

[32] Inst Nacl Perinatol, Mexico City, DF, Mexico

[33] Infect Control Directorate Minist Hlth, Kuwait, Kuwait

[34] Wroclaw Med Univ, Dept Anesthesiol & Intens Therapy, Wroclaw, Poland

[35] An Najah Natl Univ Hosp, Cardiol, Nablus, Palestine

[36] Dar Alfouad Hosp 6th of October City, 6th October City, 6th of October City, Egypt

[37] Salmaniya Med Ctr, Manama, Bahrain

[38] Univ Med & Pharm, Victor Babes Timisoara Emergency Clin Cty Hosp Rom, Timisoara, Romania

[39] Univ Fed Sao Paulo, Hosp Sao Paulo, Sao Paulo, Brazil

[40] Fudan Univ, Zhongshan Hosp, Shanghai, Peoples R China

[41] Port Moresby Gen Hosp, Port Moresby, Papua N Guinea

[42] Natl Infect Control Program, Khartoum, Sudan

[43] Grande Int Hosp, Kathmandu, Nepal

[44] Clin Ctr Serbia, Belgrade, Serbia

[45] Natl Inst Publ Hlth, Prishtina, Kosovo

[46] Hosp Nacl Ninos Benjamin Bloom, San Salvador, El Salvador

[47] Univ Peruana Ciencias Aplicadas, Hosp Emergencias Pediat, Lima, Peru

[48] Hop Ibn Sina, Rabat, Morocco

[49] NIH, Islamabad, Pakistan

[50] Amer Univ Beirut Med Ctr, Beirut, Lebanon

来源：

ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY | 2023年 / 3卷 / 01期

关键词：

INTENSIVE-CARE UNITS; DEVICE-ASSOCIATED INFECTIONS; MULTIDIMENSIONAL APPROACH; SOCIOECONOMIC IMPACT; ADULT; PREVENTION; CITIES;

D O I：

10.1017/ash.2022.339

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-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 Middle Eastern 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 variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [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), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57-15.48; P < .0001); tracheostomy connected to a MV, which was associated with the 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 was associated with the highest risk (aOR, 4.05; 95% CI, 3.22-5.09; P < .0001), admission to a neurologic ICU, which was associated with the 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 income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.

引用

页数：10

共 14 条

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Rosenthal, Victor Daniel
Bat-Erdene, Ider
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Myatra, Sheila Nainan
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Trotter, Andrew
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[13] An eight-year multicenter study on short-term peripheral intravenous catheter-related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC)
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