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. 2024 Sep 30;16(9):5518-5528.
doi: 10.21037/jtd-24-150. Epub 2024 Sep 14.

Incidence and risk factors of ventilator-associated pneumonia in the intensive care unit: a systematic review and meta-analysis

Wenze Li  1 , Jiajia Cai  1 , Liqin Ding  1 , Yanyan Chen  1 , Xiaoqin Wang  1 , Hongyan Xu  2
Affiliations

Incidence and risk factors of ventilator-associated pneumonia in the intensive care unit: a systematic review and meta-analysis

Wenze Li et al. J Thorac Dis. .

Abstract

Background: Ventilator-associated pneumonia (VAP) is a serious complication occurring in critically ill patients receiving mechanical ventilation in the intensive care unit (ICU). This study attempted to analyze VAP incidence in the ICU using a meta-analysis, investigate risk factors for VAP occurrence, and examine influence of VAP on outcomes.

Methods: A search was carried out in the Web of Science, PubMed, Embase, and The Cochrane Library databases to identify studies on incidence and risk factors of VAP in ICU patients. Study quality was tested by the Newcastle-Ottawa Scale. Data related to risk factors, incidence, and outcomes were utilized for meta-analysis. Meta-analysis was conducted using Stata 18 and Review Manager 5.4.

Results: Seventeen articles were included, comprising 6,222 patients, and incidence of VAP was 30% [95% confidence interval (CI): 24-37%]. Risk factor analysis showed that males [odds ratio (OR): 1.50; 95% CI: 1.29-1.75; P<0.001], smoking (OR: 1.30; 95% CI: 1.08-1.57; P=0.007) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score [weighted mean difference (WMD): 1.30; 95% CI: 0.31-2.30; P=0.01] were risk factors for VAP. Antibiotic prophylaxis (OR: 0.79; 95% CI: 0.63-0.99; P=0.04) was a protect factor for VAP. Compared with non-VAP patients, VAP patients had a prolonged duration of mechanical ventilation (WMD: 6.96; 95% CI: 5.42-8.50; P<0.001), ICU length of stay (WMD: 7.91; 95% CI: 5.43-10.39; P<0.001) and total length of hospital stay (WMD: 8.09; 95% CI: 3.70-12.48; P=0.0003). There was no significant difference in mortality rate between VAP and non-VAP patients (OR: 1.13; 95% CI: 0.79-1.63; P=0.50).

Conclusions: VAP incidence in the ICU was around 30%. Male, smoking, and high APACHE II score were risk factors for VAP, while antibiotic prophylaxis was a protective factor for VAP. VAP could lead to prolonged mechanical ventilation, ICU stay, and hospital stay, but it did not influence mortality.

Keywords: Ventilator-associated pneumonia (VAP); incidence; intensive care unit (ICU); mortality; risk factors.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-150/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA flow chart for the included studies.
Figure 2
Figure 2
Incidence of VAP. ES, effect size; VAP, ventilator-associated pneumonia; CI, confidence interval.
Figure 3
Figure 3
Clinical outcomes. (A) Duration of mechanical ventilation (day); (B) intensive care unit length of stay; (C) hospital length of stay; (D) mortality. VAP, ventilator-associated pneumonia; SD, standard deviation; CI, confidence interval; IV, inverse variance; M-H, Mantel-Haenszel.
See this image and copyright information in PMC

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