Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicentre prospective cohort survey
Introduction
Ventilator-associated pneumonia (VAP), defined as pneumonia that develops at least 48 h after introduction of mechanical ventilation (MV), is one of the most common healthcare-associated infections (HAIs) and an important cause of morbidity, prolonged intensive care unit (ICU) stay and additional hospital costs.1, 2, 3, 4, 5
Most studies of VAP have been conducted in developed countries.6, 7, 8, 9, 10, 11 In China there have been relatively few studies of nosocomial infection and these have generally been limited to small sample sizes and short time periods.12 This investigation reports the incidence rate, risk factors and pathogens associated with VAP in a large cohort of mechanically ventilated patients in 17 ICUs in Hubei Province, China, with the aim of benchmarking against international standards and assessing the needs for further specific infection control interventions.
Section snippets
Hospitals and ICUs
We performed a continuous, prospective, multicentre cohort study of patients who received MV in 17 ICUs in 17 tertiary care hospitals in Hubei Province, China, from January 2007 to June 2009. The hospitals, all members of the Surveillance System of Healthcare Associated Infections of Hubei Province, were located in the cities of Wuhan (7), Shiyan (2), Yichang (2), Xiangfan (2), Xiaogan (1), Suizhou (1), Jingzhou (1) and Jingmen (1). In China, tertiary care hospitals are referral centres for
Patient population and incidence rate
During the study period, 12 105 patients were admitted to the ICUs, 4155 (34.32%) of whom received MV. Of these, 60.11% were male and the mean age was 46.65 years (range: 1–95 years). During the study 30 035 MV-days were accumulated, and 868 patients (20.9%; 95% CI: 19.7–22.1) were diagnosed with VAP. The crude incidence of VAP was 28.9 episodes per 1000 ventilator-days, ranging from 8.4 to 49.3 between units (Table I).
Risk factors for VAP
The characteristics of patients with VAP included in the study are shown in
Discussion
Surveillance of VAP has been reported from both developed and developing countries. The National Healthcare Safety Network (NHSN) reported that the VAP rate in 2006 in general ICUs affiliated to 211 US hospitals ranged from 2.7 to 12.3 per 1000 MV-days, in medical ICUs was 3.1 per 1000 MV-days, and in surgical ICUs was 5.2 per 1000 MV-days.8 In the German Nosocomial Infection Surveillance System the mean VAP rate from 391 ICUs between January 2005 and December 2007 was 5.5 cases per 1000
Acknowledgements
We thank the staff who collected patient data in the 17 hospitals. In alphabetical order, the directors of departments of infection control of these hospitals are as follows: M. Deng, P. Lei, D. Li, L. Liu, R. Liu, B. Shen, D. Sun, A. Wei, Y. Wen, Y. Xu, C. Yang, S. You, F. Zhang, C. Zhou, and M. Zhou. We would like to thank Dr Y. Tang, Dr J. Peng, and Miss L. Wang for critically reviewing the manuscript.
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2020, International Emergency NursingCitation Excerpt :The results of a study in the United States reported that the direct and indirect costs of VAP is approximately $57,000 [9]. Factors such as male gender, aging, underlying diseases, chronic obstructive pulmonary diseases, low level of consciousness, the need for prolonged MV, the need for reintubation after extubation, patient's position (supine position), infections of other organs, the need for tracheostomy, the use of anti-acids, the excessive use of antibiotics and bronchoscopy can increase the chance of the occurrence of VAP in a patient [8,10]. Given the high mortality rate of such infections, prevention has always been an area of special importance [11].
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These authors contributed equally to this paper.