Jianfeng Xie1, Yi Yang1, Yingzi Huang1, Yan Kang2, Yuan Xu3, Xiaochun Ma4, Xue Wang5, Jian Liu6, Dawei Wu7, Yaoqing Tang8, Bingyu Qin9, Xiangdong Guan10, Jianguo Li11, Kaijiang Yu12, Dawei Liu13, Jing Yan14, Haibo Qiu1. 1. Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing. 2. Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu. 3. Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang. 4. Department of Critical Care Medicine, Beijing Tongren Hospital. 5. Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an JiaotTong University. 6. Department of Critical Care Medicine, The First Hospital of Lanzhou University. 7. Department of Critical Care Medicine, Qilu Hospital of Shangdong University, Jinan. 8. Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine. 9. Department of Critical Care Medicine, Henan Provincial People`s Hospital, Zhengzhou. 10. Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou. 11. Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University. 12. Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University. 13. Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing, and. 14. Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China.
Abstract
Background: Ventilator-associated pneumonia (VAP) is among the most important hospital-acquired infections in the intensive-care unit setting. However, clinical data regarding the epidemiology of VAP in China are limited. Methods: A multicenter, longitudinal, observational study was performed from March 2013 to December 2015 to prospectively collect data on patients diagnosed with VAP. Specifically, patients supported by invasive mechanical ventilation for longer than 48 hours were included. Clinical data were recorded for each VAP patient. The exact pathogen distribution and the incidence of VAP were calculated. Risk factors associated with mortality were analyzed using univariate and multivariate regression analyses. Results: A total of 2492 patients received mechanical ventilation for longer than 48 hours and were enrolled in the study. A total of 129 (5.0%) patients fulfilled the VAP criteria, and 38 (29.5%) patients were diagnosed with early-onset VAP. The incidence of VAP was 4.5 per 1000 ventilation days, with a 28-day mortality rate of 45%. Individual pathogens, including 115 bacteria and 2 fungi, were identified in 117 (90.7%) enrollees, and 87 (75.7%) bacteria were multidrug-resistant organisms. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most commonly detected pathogens causing VAP. No difference in the distribution of pathogens was observed between early- and late-onset VAP or between surviving and non-surviving patients. Multivariate regression revealed that older ages and Sequential Organ Failure Assessment Scores were correlated with increased 28-day mortality rates. Conclusions: High pathogen resistance and mortality were found in both early- and late-onset VAP. Clinical Trials Registration: NCT01943331.
Background: Ventilator-associated pneumonia (VAP) is among the most important hospital-acquired infections in the intensive-care unit setting. However, clinical data regarding the epidemiology of VAP in China are limited. Methods: A multicenter, longitudinal, observational study was performed from March 2013 to December 2015 to prospectively collect data on patients diagnosed with VAP. Specifically, patients supported by invasive mechanical ventilation for longer than 48 hours were included. Clinical data were recorded for each VAP patient. The exact pathogen distribution and the incidence of VAP were calculated. Risk factors associated with mortality were analyzed using univariate and multivariate regression analyses. Results: A total of 2492 patients received mechanical ventilation for longer than 48 hours and were enrolled in the study. A total of 129 (5.0%) patients fulfilled the VAP criteria, and 38 (29.5%) patients were diagnosed with early-onset VAP. The incidence of VAP was 4.5 per 1000 ventilation days, with a 28-day mortality rate of 45%. Individual pathogens, including 115 bacteria and 2 fungi, were identified in 117 (90.7%) enrollees, and 87 (75.7%) bacteria were multidrug-resistant organisms. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most commonly detected pathogens causing VAP. No difference in the distribution of pathogens was observed between early- and late-onset VAP or between surviving and non-surviving patients. Multivariate regression revealed that older ages and Sequential Organ Failure Assessment Scores were correlated with increased 28-day mortality rates. Conclusions: High pathogen resistance and mortality were found in both early- and late-onset VAP. Clinical Trials Registration: NCT01943331.