Zhiyong Zong1,2, Xin Sun3, Qiao He4, Wen Wang4, Shichao Zhu5, Mingqi Wang4, Yan Kang6, Rui Zhang7, Kang Zou4. 1. Department of Infection Control, West China Hospital of Sichuan University, Chengdu, 610041, China. zongzhiyong@gmail.com. 2. Center of Infection Diseases, West China Hospital of Sichuan University, Chengdu, 610041, China. zongzhiyong@gmail.com. 3. Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital of Sichuan University, Chengdu, 610041, China. sunxin@wchscu.cn. 4. Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital of Sichuan University, Chengdu, 610041, China. 5. Department of Infection Control, West China Hospital of Sichuan University, Chengdu, 610041, China. 6. Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, 610041, China. 7. Information Center, West China Hospital of Sichuan University, Chengdu, 610041, China.
Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection (HAI) in intensive care units (ICUs). Ventilator-associated event (VAE), a more objective definition, has replaced traditional VAP surveillance and is now widely used in the USA. However, the adoption outside the USA is limited. This study aims to describe the epidemiology and clinical outcomes of VAEs in China, based on a prospectively maintained registry. METHODS: An observational study was conducted using an ICU-HAI registry in west China. Patients that were admitted to ICUs and underwent mechanical ventilation (MV) between April 1, 2015, and December 31, 2018, were included. The characteristics and outcomes were compared between patients with and without VAEs. The rates of all VAEs dependent on different ICUs were calculated, and the pathogen distribution of patients with possible VAP (PVAP) was described. RESULTS: A total of 20,769 ICU patients received MV, accounting for 21,723 episodes of mechanical ventilators and 112,697 ventilator-days. In all, we identified 1882 episodes of ventilator-associated condition (VAC) events (16.7 per 1000 ventilator-days), 721 episodes of infection-related ventilator-associated complications (IVAC) events (6.4 per 1000 ventilator-days), and 185 episodes of PVAP events (1.64 per 1000 ventilator-days). The rates of VAC varied across ICUs with the highest incidence in surgical ICUs (23.72 per 1000 ventilator-days). The median time from the start of ventilation to the onset of the first VAC, IVAC, and PVAP was 5 (3-8), 5 (3-9), and 6 (4-13) days, respectively. The median length of hospital stays was 28.00 (17.00-43.00), 30.00 (19.00-44.00), and 30.00 (21.00-46.00) days for the three VAE tiers, which were all longer than that of patients without VAEs (16.00 [12.00-23.00]). The hospital mortality among patients with VAEs was more than three times of those with non-VAEs. CONCLUSIONS: VAE was common in ICU patients with ≥ 4 ventilator days. All tiers of VAEs were highly correlated with poor clinical outcomes, including longer ICU and hospital stays and increased risk of mortality. These findings highlight the importance of VAE surveillance and the development of new strategies to prevent VAEs.
BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection (HAI) in intensive care units (ICUs). Ventilator-associated event (VAE), a more objective definition, has replaced traditional VAP surveillance and is now widely used in the USA. However, the adoption outside the USA is limited. This study aims to describe the epidemiology and clinical outcomes of VAEs in China, based on a prospectively maintained registry. METHODS: An observational study was conducted using an ICU-HAI registry in west China. Patients that were admitted to ICUs and underwent mechanical ventilation (MV) between April 1, 2015, and December 31, 2018, were included. The characteristics and outcomes were compared between patients with and without VAEs. The rates of all VAEs dependent on different ICUs were calculated, and the pathogen distribution of patients with possible VAP (PVAP) was described. RESULTS: A total of 20,769 ICU patients received MV, accounting for 21,723 episodes of mechanical ventilators and 112,697 ventilator-days. In all, we identified 1882 episodes of ventilator-associated condition (VAC) events (16.7 per 1000 ventilator-days), 721 episodes of infection-related ventilator-associated complications (IVAC) events (6.4 per 1000 ventilator-days), and 185 episodes of PVAP events (1.64 per 1000 ventilator-days). The rates of VAC varied across ICUs with the highest incidence in surgical ICUs (23.72 per 1000 ventilator-days). The median time from the start of ventilation to the onset of the first VAC, IVAC, and PVAP was 5 (3-8), 5 (3-9), and 6 (4-13) days, respectively. The median length of hospital stays was 28.00 (17.00-43.00), 30.00 (19.00-44.00), and 30.00 (21.00-46.00) days for the three VAE tiers, which were all longer than that of patients without VAEs (16.00 [12.00-23.00]). The hospital mortality among patients with VAEs was more than three times of those with non-VAEs. CONCLUSIONS: VAE was common in ICU patients with ≥ 4 ventilator days. All tiers of VAEs were highly correlated with poor clinical outcomes, including longer ICU and hospital stays and increased risk of mortality. These findings highlight the importance of VAE surveillance and the development of new strategies to prevent VAEs.
Authors: Carolina A M Schurink; Christianne A Van Nieuwenhoven; Jan A Jacobs; Maja Rozenberg-Arska; Hans C A Joore; Erik Buskens; Andy I M Hoepelman; Marc J M Bonten Journal: Intensive Care Med Date: 2003-10-18 Impact factor: 17.440
Authors: Jennifer P Stevens; Bartlomiej Kachniarz; Sharon B Wright; Jean Gillis; Daniel Talmor; Peter Clardy; Michael D Howell Journal: Crit Care Med Date: 2014-03 Impact factor: 7.598
Authors: Anthony F Boyer; Noah Schoenberg; Hilary Babcock; Kathleen M McMullen; Scott T Micek; Marin H Kollef Journal: Chest Date: 2015-01 Impact factor: 9.410
Authors: Wilhelmina G Melsen; Maroeska M Rovers; Rolf H H Groenwold; Dennis C J J Bergmans; Christophe Camus; Torsten T Bauer; Ernst W Hanisch; Bengt Klarin; Mirelle Koeman; Wolfgang A Krueger; Jean-Claude Lacherade; Leonardo Lorente; Ziad A Memish; Lee E Morrow; Giuseppe Nardi; Christianne A van Nieuwenhoven; Grant E O'Keefe; George Nakos; Frank A Scannapieco; Philippe Seguin; Thomas Staudinger; Arzu Topeli; Miquel Ferrer; Marc J M Bonten Journal: Lancet Infect Dis Date: 2013-04-25 Impact factor: 25.071
Authors: John Muscedere; Tasnim Sinuff; Daren K Heyland; Peter M Dodek; Sean P Keenan; Gordon Wood; Xuran Jiang; Andrew G Day; Denny Laporta; Michael Klompas Journal: Chest Date: 2013-11 Impact factor: 9.410
Authors: Shelley S Magill; Jonathan R Edwards; Wendy Bamberg; Zintars G Beldavs; Ghinwa Dumyati; Marion A Kainer; Ruth Lynfield; Meghan Maloney; Laura McAllister-Hollod; Joelle Nadle; Susan M Ray; Deborah L Thompson; Lucy E Wilson; Scott K Fridkin Journal: N Engl J Med Date: 2014-03-27 Impact factor: 91.245
Authors: Sreeja K Vamsi; Rama S Moorthy; Mary N Hemiliamma; Rama B Chandra Reddy; Deepak J Chanderakant; Shravani Sirikonda Journal: Saudi Med J Date: 2022-03 Impact factor: 1.422
Authors: Oliver Wolffers; Martin Faltys; Janos Thomann; Stephan M Jakob; Jonas Marschall; Tobias M Merz; Rami Sommerstein Journal: Sci Rep Date: 2021-11-15 Impact factor: 4.379