Geographic variation in susceptibility to ventilator-associated pneumonia after traumatic injury.
Geographic variation in susceptibility to ventilator-associated pneumonia after traumatic injury.
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DOI：
10.1097/ta.0b013e3182924c18
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发表时间：
2013-08
期刊：
影响因子：
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通讯作者：
Fabian TC
中科院分区：
文献类型：
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作者：
Zarzaur BL;Bell TM;Croce MA;Fabian TC
随着医院开始对此类感染承担财务责任，对预防包括呼吸机相关性肺炎（VAP）在内的医疗保健相关感染（HAI）的重视程度有所增加。HAI通常被认为是可以避免的;然而，文献表明完全预防可能是不可能的。绝大多数关于VAP危险因素的研究涉及个体水平因素。没有研究调查患者入院前环境的作用。本研究旨在探讨院前环境在VAP病因学中的潜在作用。在一项回顾性队列研究中，分析了1996-2010年间接受机械通气治疗的5，031例创伤患者的样本，以确定邻居对发生VAP概率的影响。我们使用多水平逻辑回归分析评估邮政编码的影响，调整与VAP相关的个体水平因素。我们确定了三个邮政编码与呼吸机相关性肺炎的发病率与平均值有显著差异。Logistic回归分析显示，邮政编码、年龄、性别、种族、损伤严重程度、瘫痪、头部损伤和使用呼吸机天数与VAP显著相关。然而，邮政编码收入的中位数却没有。独立于医疗质量的空间因素可能会增加患者发生VAP和其他类型医疗获得性感染的可能性。不可改变的环境患者特征可能使某些人群在创伤环境中易于发生感染。III
Emphasis on prevention of healthcare-associated infections (HAI) including ventilator-associated pneumonia (VAP) has increased as hospitals are beginning to be held financially accountable for such infections. HAIs are often represented as being avoidable; however, the literature indicates that complete preventability may not be possible. The vast majority of research on risk factors for VAP concerns individual level factors. No studies have investigated the role of the patient's environment prior to admission. In this study we aim to investigate the potential role pre-hospital environment plays in VAP etiology. In a retrospective cohort study, a sample of 5,031 trauma patients treated with mechanical ventilation between 1996–2010 was analyzed to determine the effect of neighborhood on the probability of developing VAP. We evaluated the effect of zip code using multilevel logistic regression analysis adjusting for individual level factors associated with VAP. We identified three zip codes with rates of ventilator-associated pneumonia that differed significantly from the mean. Logistic regression indicated that zip code, age, gender, race, injury severity, paralysis, head injury, and number of days on the ventilator were significantly associated with VAP. However, median zip code income was not. Spatial factors that are independent of health care quality may potentiate the likelihood of a patient developing VAP and possibly other types of healthcare acquired infections. Un-modifiable environmental patient characteristics may predispose certain populations to developing infections in the setting of trauma. III