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. 2023 Jul;51(7):751-757.
doi: 10.1016/j.ajic.2022.11.005. Epub 2022 Nov 15.

Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

Victor Daniel Rosenthal  1 , Ruijie Yin  2 , Camilla Rodrigues  3 , Sheila Nainan Myatra  4 , Jigeeshu Vasishth Divatia  4 , Sanjay K Biswas  4 , Anjana Mahesh Shrivastava  4 , Mohit Kharbanda  5 , Bikas Nag  5 , Yatin Mehta  6 , Smita Sarma  6 , Subhash Kumar Todi  7 , Mahuya Bhattacharyya  7 , Arpita Bhakta  8 , Chin Seng Gan  8 , Michelle Siu Yee Low  8 , Marissa Bt Madzlan Kushairi  8 , Soo Lin Chuah  8 , Qi Yuee Wang  8 , Rajesh Chawla  9 , Aakanksha Chawla Jain  9 , Sudha Kansal  9 , Roseleen Kaur Bali  9 , Rajalakshmi Arjun  10 , Narangarav Davaadagva  9 , Batsuren Bat-Erdene  10 , Tsolmon Begzjav  10 , Mat Nor Mohd Basri  11 , Chian-Wern Tai  11 , Pei-Chuen Lee  11 , Swee-Fong Tang  12 , Kavita Sandhu  13 , Binesh Badyal  13 , Ankush Arora  13 , Deep Sengupta  13 , Lili Tao  14 , Zhilin Jin  2
Affiliations

Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

Victor Daniel Rosenthal et al. Am J Infect Control. 2023 Jul.

Abstract

Background: Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.

Methods: We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).

Results: 153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P<.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P<.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P<.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p<.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p<.0001); public (OR=1.84; 95%CI=1.49-2.26, P<.0001), and private (OR=1.57; 95%CI=1.29-1.91, P<.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P<.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P<.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P<.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P<.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P<.0001) showed the highest risk.

Conclusions: Some identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.

Keywords: Intensive care unit; International nosocomial infection control consortium; Limited resources countries; Low and middle income countries; Nosocomial pneumonia.

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