Epidemiology and outcomes of ventilator-associated pneumonia in a large US database
Epidemiology and outcomes of ventilator-associated pneumonia in a large US database
复制标题
DOI：
10.1378/chest.122.6.2115
复制
发表时间：
2002-12-01
期刊：
影响因子：
9.6
通讯作者：
Kollef, MH
中科院分区：
文献类型：
--
作者：
Rello, J;Ollendorf, DA;Kollef, MH
目的：评估呼吸机相关性肺炎 (VAP) 的危险因素及其对院内死亡率、资源利用率和住院费用的影响。设计：使用来自美国大型住院患者数据库的数据进行回顾性匹配队列研究。患者：1998 年 1 月至 1999 年 6 月入住 ICU 并接受机械通气 > 24 小时的患者。测量：使用粗比值比和调整比值比 (AOR) 检查 VAP 的危险因素。 VAP 病例在机械通气持续时间、入院时疾病严重程度（预测死亡率）、入院类型（内科、外科、创伤）和年龄方面与最多 3 名对照受试者进行匹配。然后比较病例和对照受试者之间的死亡率、资源利用率和医院收费。结果：在符合研究进入标准的 9,080 名患者中，842 名患者 (9.3%) 出现 VAP。插管、入住 ICU、入院和识别 VAP 之间的平均间隔分别为 3.3 天、4.5 天和 5.4 天。已确定的发生 VAP 的独立危险因素是男性、创伤入院和基础疾病严重程度的中间十分位（入院时）[AOR 分别为 1.58、1.75 和 1.47 至 1.70]。患有 VAP 的患者与 2,243 名没有 VAP 的对照受试者进行匹配。病例和匹配对照受试者之间的医院死亡率没有显着差异（30.5% vs 30.4%，p = 0.713）。尽管如此，VAP 患者的机械通气时间（14.3 +/- 15.5 天 vs 4.7 +/- 7.0 天，p < 0.001）、ICU 住院时间（11.7 +/- 11.0 天 vs 5.6 +/- 6.1 天，p < 0.001）和住院时间（25.5 +/- 22.8 天 vs 14.0 +/- 0.001）明显更长。 14.6 天，p < 0.001）。 VAP 的发生还与每名患者的平均住院费用增加 > 40,000 美元有关（104,983 +/- 91,080 美元 vs 63,689 +/- 75,030 美元，p < 0.001）。结论：这项同类最大的回顾性匹配队列研究表明，VAP 是一种常见的医院感染，与不良的临床和经济结果相关。虽然预防 VAP 发生的策略可能不会降低死亡率，但它们可能会给患者、其家人和医院系统带来其他重要的好处。
Objectives: To evaluate risk factors for ventilator-associated pneumonia (VAP), as well as its influence on in-hospital mortality, resource utilization, and hospital charges.Design: Retrospective matched cohort study using data from a large US inpatient database.Patients: Patients admitted to an ICU between January 1998 and June 1999 who received mechanical ventilation for > 24 h.Measurements: Risk factors for VAP were examined using crude and adjusted odds ratios (AORs). Cases of VAP were matched on duration of mechanical ventilation, severity of illness on admission (predicted mortality), type of admission (medical, surgical, trauma), and age with up to three control subjects. Mortality, resource utilization, and billed hospital charges were then compared between cases and control subjects.Results: Of the 9,080 patients meeting study entry criteria, VAP developed in 842 patients (9.3%). The mean interval between intubation, admission to the ICU, hospital admission, and the identification of VAP was 3.3 days, 4.5 days, and 5.4 days, respectively. Identified independent risk factors for the development of VAP were male gender, trauma admission, and intermediate deciles of underlying illness severity (on admission) [AOR, 1.58, 1.75, and 1.47 to 1.70, respectively]. Patients with VAP were matched with 2,243 control subjects without VAP. Hospital mortality did not differ significantly between cases and matched control subjects (30.5% vs 30.4%, p = 0.713). Nevertheless, patients with VAP had a significantly longer duration of mechanical ventilation (14.3 +/- 15.5 days vs 4.7 +/- 7.0 days, p < 0.001), ICU stay (11.7 +/- 11.0 days vs 5.6 +/- 6.1 days, p < 0.001), and hospital stay (25.5 +/- 22.8 days vs 14.0 +/- 14.6 days, p < 0.001). Development of VAP was also associated with an increase of > $40,000 in mean hospital charges per patient ($104,983 +/- $91,080 vs $63,689 +/- $75,030, p < 0.001).Conclusions: This retrospective matched cohort study, the largest of its kind, demonstrates that VAP is a common nosocomial infection that is associated with poor clinical and economic outcomes. While strategies to prevent the occurrence of VAP may not reduce mortality, they may yield other important benefits to patients, their families, and hospital systems.