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The Epidemiology of Ventilator-Associated Pneumonia in a Network of Community Hospitals: A Prospective Multicenter Study

  • Mi Suk Lee (a1) (a2), Vanessa Walker (a3), Luke F. Chen (a1), Daniel J. Sexton (a1) and Deverick J. Anderson (a1)...

Abstract

Objective.

To describe the epidemiology of ventilator-associated pneumonia (VAP) in community hospitals.

Design and Setting.

Prospective study in 31 community hospitals from 2007 to 2011.

Methods.

VAP surveillance was performed by infection preventionists using the National Healthcare Safety Network protocol. VAP incidence was reported as number of events per 1,000 ventilator-days. We categorized hospitals into small (<30,000 patient-days/year), medium (30,000–60,000 patient-days/year), and large (>60,000 patient-days/year) groups and compared VAP incidence by hospital size.

Results.

The median VAP incidence was 1.4 (interquartile range, 0.4–2.4), and ventilator utilization ratio (VUR) was 0.33 (0.25–0.47). VAP incidence was higher in small hospitals (2.1) than medium (0.85) or large (0.69) hospitals (P = .03) despite a lower VUR in small hospitals (0.29 vs 0.31 vs 0.44, respectively; P = .01). The median age of 247 VAP cases was 64 (53-73); 136 (55.1%) were female; 142 (57.5%) were Caucasian; 170 (68.8%) were admitted from home. The length of stay and duration of ventilation were 26 (14–42) and 12 (4–21) days, respectively. The pre- and postinfection hospital stays were 8 (3–13) days and 14 (8–30) days, respectively. Data on outcomes were available in 214 cases (86.6%), and 75 (35.0%) cases died during hospitalization. The top 3 pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n = 70, 27.9%), Pseudomonas species (n = 40, 16.3%), and Klebsiella species (n = 34, 13.3%).

Conclusions.

VAP incidence was inversely associated with size of hospital. VAP in community hospitals was frequently caused by MRSA. Importantly, predictors of VAP incidence in tertiary care hospitals such as VUR may not be predictive in community hospitals with few ventilated patients.

Copyright

Corresponding author

DUMC Box 102359, Duke University Medical Center, Durham, NC 27710 (deverick.anderson@duke.edu)

References

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1.Kollef, MHS, Afessa, B, Anzueto, A, et al. Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008;300:805813.
2.Bercault, N, Boulain, T. Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult intensive care unit: a prospective case control study. Crit Care Med 2001;29: 23032309.
3.Hortal, J, Giannella, M, Pérez, MJ, et al. Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Med 2009;35:15181525.
4.Magret, M, Amaya-Villar, R, Garnacho, J, et al. Ventilator-associated pneumonia in trauma patients is associated with lower mortality: results from EU-VAP study. J Trauma 2010;69:849854.
5.Vanhems, P, Bénet, T, Voirin, N, et al. Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study. BMC Infect Dis 2011;6;11:236.
6.Chung, DR, Song, JH, Kim, SH, et al. High prevalence of mul-tidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med 2011;184:14091417.
7.Ibrahim, EH, Tracy, L, Hill, C, Fraser, VJ, Kollef, MH. The occurrence of ventilator-associated pneumonia in a community hospital: risk factors and clinical outcomes. Chest 2001;120:555561.
8.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.
9.Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011;39:349367.
10.Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315322.
11.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.
12.Sundar, KM, Nielsen, D, Sperry, P. Comparison of ventilator-associated pneumonia (VAP) rates between different ICUs: implications of a zero VAP rate. J Crit Care 2012;27:2632.
13.DePalo, VA, McNicoll, L, Cornell, M, Rocha, JM, Adams, L, Pronovost, PJ. The Rhode Island ICU collaborative: a model for reducing central line-associated bloodstream infection and ventilator-associated pneumonia statewide. Qual Saf Health Care 2010;19:555561.
14.Bouadma, L, Deslandes, E, Lolom, I, et al. Long-term impact of a multifaceted prevention program on ventilator-associated pneumonia in a medical intensive care unit. Clin Infect Dis 2010;51:11151122.
15.Blot, S, Lisboa, T, Angles, R, Relio, J. Prevention of VAP: is zero rate possible? Clin Chest Med 2011;32:591599.
16.Anderson, DJ, Hartwig, MG, Pappas, T, et al. Surgical volume and the risk of surgical site infection in community hospitals: size matters. Ann Surg 2008;247:343349.
17.Kahn, JM, Goss, CH, Heagerty, PJ, Kramer, AA, O'Brien, CR, Rubenfeld, GD. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006;355:4150.
18.Klompas, M, Kleinman, KP, Karcz, A. Variability in mean duration of mechanical ventilation among community hospitals. Infect Control Hosp Epidemiol 2012;33:635637.
19.Cook, DJ, Walter, SD, Cook, RJ, et al. Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 1998;129:433440.
20.Ranes, JL, Gordon, SM, Chen, P, et al. Predictors of long-term mortality in patients with ventilator-associated pneumonia. Am J Med 2006;119:e13e19.
21.Tejerina, E, Frutos-Vivar, F, Restrepo, MI, et al. Incidence, risk factors, and outcome of ventilator-associated pneumonia. J Crit Care 2006;21:5665.
22.Kollef, MH, Shorr, A, Tabak, YP, Gupta, V, Liu, LZ, Johannes, RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005;128:38543862.
23.Rosenthal, VD, Maki, DG, Jamulitrat, S, Medeiros, EA, Todi, SK, Gomez, DY. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control 2010;38:95104.
24.Klompas, M, Piatt, R. Ventilator-associated pneumonia: the wrong quality measure for benchmarking. Ann Intern Med 2007;147:803805.
25.Klompas, M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control 2010;38:237239.
26. Improving surveillance for ventilator-associated events in adults. Center for Disease Control and Prevention (CDC) website. http://www.cdc.gov/nhsn/PDFs/vae/CDC_VAE_CommunicationsSummary-forcompliance_20120313.pdf. Accessed July 10, 2012.

The Epidemiology of Ventilator-Associated Pneumonia in a Network of Community Hospitals: A Prospective Multicenter Study

  • Mi Suk Lee (a1) (a2), Vanessa Walker (a3), Luke F. Chen (a1), Daniel J. Sexton (a1) and Deverick J. Anderson (a1)...

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