Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)

Rosenthal VD 1 , Jin Z 1 , Memish ZA 2 , Rodrigues C 3 , Myatra SN 4 , Kharbanda M 5 Show all authors , Valderrama-Beltran SL 6 , Mehta Y 7 , Daboor MA 8 , Todi SK 9 , Aguirre-Avalos G 10 , Guclu E 11 , Gan CS 12 , Jiménez Alvarez LF 13 , Chawla R 14 , Hlinkova S 15 , Arjun R 16 , Agha HM 17 , Zuniga Chavarria MA 18 , Davaadagva N 19 , Mohd Basri MN 20 , Gomez K 21 , Aguilar De Moros D 22 , Tai CW 23 , Sassoe Gonzalez A 24 , Aguilar Moreno LA 25 , Sandhu K 26 , Janc J 27 , Aleman Bocanegra MC 28 , Yildizdas D 29 , Cano Medina YA 30 , Villegas Mota MI 31 , Omar AA 32 , Duszynska W 33 , BelKebir S 34 , El-Kholy AA 35 , Abdulaziz Alkhawaja S 36 , Horhat Florin G 37 , Medeiros EA 38 , Tao L 39 , Tumu N 40 , Elanbya MG 41 , Dongol R 42 , Mioljević V 43 , Raka L 44 , Dueñas L 45 , Carreazo NY 46 , Dendane T 47 , Ikram A 48 , Kanj SS 49 , Petrov MM 50 , Bouziri A 51 , Hung NV 52 , Belskiy V 53 , Elahi N 54 , Bovera MM 55 , Yin R 1

Affiliations 

  • 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
  • 2 King Saud Medical City, Ministry of Health, Riyadh, the Kingdom of Saudi Arabia
  • 3 Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
  • 4 Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
  • 5 Desun Hospital, Kolkata, India
  • 6 Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogotá, Colombia
  • 7 Medanta the Medicity, Haryana, India
  • 8 King Hussein Cancer Center, Amman, Jordan
  • 9 Advanced Medicare Research Institute (AMRI) Hospitals, Kolkata, India
  • 10 Hospital Civil de Guadalajara Fray Antonio Alcalde. Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
  • 11 Sakarya University Training and Research Hospital, Sakarya, Turkey
  • 12 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 13 Clinica Universitaria Colombia, Bogotá, Colombia
  • 14 Indraprastha Apollo Hospitals, New Delhi, India
  • 15 Catholic University in Ruzomberok, Faculty of Health, Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
  • 16 Kerala Institute of Medical Sciences and Health, Trivandrum, India
  • 17 Cairo University Specialized Pediatric Hospital, Cairo, Egypt
  • 18 Hospital Clínica Biblica, San José de Costa Rica, Costa Rica
  • 19 Intermed Hospital, Ulaanbaatar, Mongolia
  • 20 International Islamic University Malaysia, Kuantan Pahang, Malaysia
  • 21 Clinica Sebastián de Belalcázar, Cali, Colombia
  • 22 Hospital del Niño Dr José Renán Esquivel, Panamá, Panamá
  • 23 Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
  • 24 Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, México
  • 25 Clinica Infantil Santa María del Lago, Bogotá, Colombia
  • 26 Max Super Specialty Hospital Saket Delhi, New Delhi, India
  • 27 Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
  • 28 Hospital San José TecSalud, Monterrey, Nuevo Leon, Mexico
  • 29 Cukurova University. Balcali Hospital, Adana, Turkey
  • 30 Instituto Del Corazón De Bucaramanga Sede Bogotá, Bogotá, Colombia
  • 31 Instituto Nacional de Perinatología, México DF, México
  • 32 Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
  • 33 Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University. Wroclaw, Poland
  • 34 An Najah National University Hospital, Nablus, Palestine
  • 35 Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt
  • 36 Salmaniya Medical Center, Manama, Bahrain
  • 37 University of Medicine and Pharmacy, Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
  • 38 Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
  • 39 Zhongshan Hospital, Fudan University, Shanghai, China
  • 40 Port Moresby General Hospital, Port Moresby, Papua New Guinea
  • 41 National Infection control Program, Khartoum, Sudan
  • 42 Grande International Hospital, Kathmandu, Nepal
  • 43 Clinical center of Serbia, Belgrade, Serbia
  • 44 National Institute For Public Health, Prishtina, Kosovo
  • 45 Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
  • 46 Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
  • 47 Hôpital Ibn Sina, Rabat, Morocco
  • 48 National Institutes of Health, Islamabad, Pakistan
  • 49 American University Of Beirut Medical Center, Beirut, Lebanon
  • 50 St George University Hospital, Plovdiv, Bulgaria
  • 51 Hôpital d'enfants, Tunis, Tunisia
  • 52 Bach Mai Hospital, Hanoi, Vietnam
  • 53 Privolzhskiy District Medical Center, Nizhniy Novgorod, Russia
  • 54 Dubai Hospital, Dubai, United Arab Emirates
  • 55 Hospital De Los Valles, Ecuador
Antimicrob Steward Healthc Epidemiol, 2023;3(1):e6.
PMID: 36714281 DOI: 10.1017/ash.2022.339

Abstract

OBJECTIVE: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs.

DESIGN: Prospective cohort study.

SETTING: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries.

PARTICIPANTS: The study included patients admitted to ICUs across 24 years.

RESULTS: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16-1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07-1.08; P < .0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23-1.31; P < .0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57-15.48; P < .0001); tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31; 95% CI, 7.21-9.58; P < .0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34-7.21; P < .0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17-1.29; P < .0001); admission to a public hospital (aOR, 1.59; 95% CI, 1.35-1.86; P < .0001); middle-income country (aOR, 1.22; 95% CI, 15-1.29; P < .0001); admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05; 95% CI, 3.22-5.09; P < .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48; 95% CI, 1.78-3.45; P < .0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79-3.07; P < .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51-0.77; P < .0001).

CONCLUSIONS: Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

Similar publications