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Meta-Analysis
. 2017 Jul 4;17(1):468.
doi: 10.1186/s12879-017-2566-7.

Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis

Chengyi Ding  1 , Yuelun Zhang  2 , Zhirong Yang  3 , Jing Wang  1 , Aoming Jin  1 , Weiwei Wang  1 , Ru Chen  1 , Siyan Zhan  4
Affiliations
Meta-Analysis

Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis

Chengyi Ding et al. BMC Infect Dis. .

Abstract

Background: Data to date is far from sufficient to describe the recent epidemiology of ventilator-associated pneumonia (VAP) in mainland China. This study aimed to estimate the overall incidence of VAP, with a special focus on its temporal trend and associated factors.

Methods: Meta-analyses of 195 studies published from 2010 to 2015 were conducted, followed by subgroup analyses by methodological quality, pre-defined setting characteristics and attributes of populations.

Results: The overall cumulative VAP incidence in mainland China was 23.8% (95% confidence interval (CI) 20.6-27.2%), with the results showing high heterogeneity. The pooled incidence densities were 24.14 (95% CI 21.19-27.51) episodes and 22.83 (95% CI 19.88-26.23) patients per 1000 ventilator-days. A decline in the cumulative incidence was observed from 2006 (49.5%, 95% CI 40.0-59.0%) to 2014 (19.6%, 95% CI 10.4-31.0%); differences in the incidence rates were also documented according to Chinese provinces and diagnostic criteria (p < 0.001). Older age (≥60 years), coma, re-intubation, tracheotomy and prolonged ventilation were the factors significantly associated with the occurrence of VAP.

Conclusions: The incidence of VAP remains high in mainland China but has decreased since 2006. The reported rates vary considerably across individual studies, probably due to variations in diagnosis and geographical region. More studies using standard definitions and cut-off points are needed to better clarify the epidemiology of VAP across the country.

Keywords: China; Incidence; Meta-analysis; Risk factors; Ventilator-associated pneumonia.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of study inclusion
Fig. 2
Fig. 2
Summary of risk of bias for all the included studies
Fig. 3
Fig. 3
Pooled cumulative incidence of VAP in mainland China at different study periods. Random-effects model was used to pool the individual cumulative incidence of each included study
Fig. 4
Fig. 4
Geographic map showing cumulative incidence of VAP in different Chinese provinces. Map was generated using Mapinfo Professional 11.0 software based on the subgroup analysis by province. Random-effects model was used to pool the provincial cumulative incidence of VAP
See this image and copyright information in PMC

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