Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

Victor Daniel Rosenthal; Ruijie Yin; Camilla Rodrigues; Sheila Nainan Myatra; Jigeeshu Vasishth Divatia; Sanjay K Biswas; Anjana Mahesh Shrivastava; Mohit Kharbanda; Bikas Nag; Yatin Mehta; Smita Sarma; Subhash Kumar Todi; Mahuya Bhattacharyya; Arpita Bhakta; Chin Seng Gan; Michelle Siu Yee Low; Marissa Bt Madzlan Kushairi; Soo Lin Chuah; Qi Yuee Wang; Rajesh Chawla; Aakanksha Chawla Jain; Sudha Kansal; Roseleen Kaur Bali; Rajalakshmi Arjun; Narangarav Davaadagva; Batsuren Bat-Erdene; Tsolmon Begzjav; Mat Nor Mohd Basri; Chian-Wern Tai; Pei-Chuen Lee; Swee-Fong Tang; Kavita Sandhu; Binesh Badyal; Ankush Arora; Deep Sengupta; Lili Tao; Zhilin Jin

doi:10.1016/j.ajic.2022.11.005

Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

Am J Infect Control. 2023 Jul;51(7):751-757. doi: 10.1016/j.ajic.2022.11.005. Epub 2022 Nov 15.

Authors

Victor Daniel Rosenthal¹, Ruijie Yin², Camilla Rodrigues³, Sheila Nainan Myatra⁴, Jigeeshu Vasishth Divatia⁴, Sanjay K Biswas⁴, Anjana Mahesh Shrivastava⁴, Mohit Kharbanda⁵, Bikas Nag⁵, Yatin Mehta⁶, Smita Sarma⁶, Subhash Kumar Todi⁷, Mahuya Bhattacharyya⁷, Arpita Bhakta⁸, Chin Seng Gan⁸, Michelle Siu Yee Low⁸, Marissa Bt Madzlan Kushairi⁸, Soo Lin Chuah⁸, Qi Yuee Wang⁸, Rajesh Chawla⁹, Aakanksha Chawla Jain⁹, Sudha Kansal⁹, Roseleen Kaur Bali⁹, Rajalakshmi Arjun¹⁰, Narangarav Davaadagva⁹, Batsuren Bat-Erdene¹⁰, Tsolmon Begzjav¹⁰, Mat Nor Mohd Basri¹¹, Chian-Wern Tai¹¹, Pei-Chuen Lee¹¹, Swee-Fong Tang¹², Kavita Sandhu¹³, Binesh Badyal¹³, Ankush Arora¹³, Deep Sengupta¹³, Lili Tao¹⁴, Zhilin Jin²

Affiliations

¹ Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA; International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, USA. Electronic address: vdr21@med.miami.edu.
² Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA.
³ Pd Hinduja National Hospital, and Medical Research Centre, Department of Microbiology, Mumbai, India.
⁴ Tata Memorial Hospital, Homi Bhabha National Institute, Department of Anesthesiology, Critical Care and Pain, Mumbai, India.
⁵ Desun Hospital, Department of Critical Care, Kolkata, India.
⁶ Medanta The Medicity, Department of Critical Care and Anesthesiology, Haryana, India.
⁷ Advanced Medicare Research Institute AMRI Hospitals, Department of Critical Care, Kolkata, India.
⁸ University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia.
⁹ Indraprastha Apollo Hospitals, Department of Critical Care, New Delhi, India.
¹⁰ Kerala Institute of Med Sciences Health, Department of Critical Care, Trivandrum, India.
¹¹ International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan Pahang, Malaysia.
¹² Universiti Kebangsaan Malaysia Specialist Children's Hospital, Department of Critical Care, Kuala Lumpur, Malaysia.
¹³ Max Super Speciality Hospital Saket Delhi, Department of Critical Care, New Delhi, India.
¹⁴ Zhongshan Hospital, Fudan University, Department of Pneumonology, Shanghai, China.

PMID: 36400318
DOI: 10.1016/j.ajic.2022.11.005

Abstract

Background: Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.

Methods: We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).

Results: 153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P<.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P<.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P<.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p<.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p<.0001); public (OR=1.84; 95%CI=1.49-2.26, P<.0001), and private (OR=1.57; 95%CI=1.29-1.91, P<.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P<.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P<.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P<.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P<.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P<.0001) showed the highest risk.

Conclusions: Some identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.

Keywords: Intensive care unit; International nosocomial infection control consortium; Limited resources countries; Low and middle income countries; Nosocomial pneumonia.

MeSH terms

Cross Infection* / prevention & control
Hospitals, Teaching
Humans
Intensive Care Units
Male
Pakistan
Pneumonia, Ventilator-Associated* / epidemiology
Pneumonia, Ventilator-Associated* / prevention & control
Prospective Studies
Risk Factors