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Meta-Analysis
. 2019 Jan 18;68(3):511-518.
doi: 10.1093/cid/ciy543.

A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology

Ana Bonell  1 , Ryan Azarrafiy  2 , Vu Thi Lan Huong  1 , Thanh Le Viet  1 , Vu Dinh Phu  3 , Vu Quoc Dat  4 , Heiman Wertheim  5   6 , H Rogier van Doorn  1 , Sonia Lewycka  1 , Behzad Nadjm  1
Affiliations
Meta-Analysis

A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology

Ana Bonell et al. Clin Infect Dis. .

Abstract

Background: Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia.

Methods: We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level.

Results: Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%).

Conclusions: VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.

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Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 flow diagram [14].
Figure 2.
Figure 2.
Mapped period prevalence rates of ventilator-associated pneumonia for 74 studies in Asia. The prevalence rates reported are color coded. Source: http://naturalearthdata.com.
Figure 3.
Figure 3.
A, Pooled microbiology results of ventilator-associated pneumonia (VAP) etiology by country income level. B, Pooled microbiology results of VAP etiology by geographic area (tropical vs nontropical). Abbreviations: HIC, high-income country; LMIC, low-/lower-middle-income country; UMIC, upper-middle-income country.
Figure 4.
Figure 4.
Mapped pooled microbiology results by country for etiology of ventilator-associated pneumonia. Organisms are color coded, and the size of the pie chart reflects the total number of isolates identified per country. Source: http://naturalearthdata.com.
See this image and copyright information in PMC

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