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Clinical Investigations in Critical CareEpidemiology and Outcomes of Ventilator-Associated Pneumonia in a Large US Database
Section snippets
Study Design
A retrospective matched cohort study was undertaken to examine the incidence of VAP, to identify risk factors associated with its development, and to assess the impact of VAP on clinical and economic outcomes. Data were obtained for all patients admitted to an ICU from January 1998 to June 1999 who received mechanical ventilation for > 24 h. Cases of VAP were defined as patients with hospital-acquired pneumonia diagnoses occurring ≥ 24 h following intubation. Control subjects without VAP
Patient Characteristics and Risk Factors for VAP
In the database, 9,080 patients met all study entry criteria. Among these patients, VAP developed in 842 patients (9.3%). The mean interval between intubation, ICU admission, hospital admission, and identification of VAP was 3.3 ± 6.6 days, 4.5 ± 7.5 days, and 5.4 ± 7.7 days, respectively. Patients with VAP were significantly younger, more likely to be male, had intermediate deciles of illness severity, had a greater incidence of coma or stupor, and were more frequently admitted for trauma
Discussion
This is the largest US study of patients with VAP performed to date. These data suggest that VAP is a common hospital-acquired infection occurring in 9.3% of patients requiring mechanical ventilation for > 24 h. Male gender, trauma admission, and intermediate predicted risks of mortality were identified as independent risk factors associated with VAP. The case-control analysis we performed demonstrated no attributable mortality associated with VAP. However, patients with VAP had other
Appendix
Members of the VAP Outcomes Scientific Advisory Group include Marc Bonten, MD, PhD, University Medical Center, Utrecht, the Netherlands; Jean Carlet, MD (Co-Chair), Hôpital St. Joseph, Paris, France; Deborah Cook, MD, St. Joseph’s Hospital, Hamilton, ON, Canada; Jean-Yves Fagon, MD, Hôpital European Georges Pompidou, Paris, France; Mike Niederman, MD, Winthrop University Hospital, Mineola, NY; and Janet Wittes, PhD, Statistics Collaborative, Washington, DC.
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Supported in part by unrestricted grants from IntraBiotics Pharmaceuticals, Inc. and the Barnes-Jewish Hospital Foundation.
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A list of VAP Outcomes Scientific Advisory Group members is located in the Appendix