Ventilator-associated pneumonia: caveats for benchmarking
Ventilator-associated pneumonia: caveats for benchmarking
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DOI：
10.1007/s00134-003-1991-9
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发表时间：
2003-11-01
影响因子：
38.9
通讯作者：
Pittet, D
中科院分区：
文献类型：
--
作者：
Eggimann, P;Hugonnet, S;Pittet, D
Objective.确定使用不同呼吸机对呼吸机相关性肺炎（VAP）风险估计的影响。设计和设置。在一家大型教学医院的内科ICU中进行的前瞻性队列研究。患者1995年10月至1997年11月期间连续住院超过48小时的所有患者。我们使用改良的CDC标准记录了所有ICU获得性感染。VAP发生率报告为每1,000患者日、风险患者日、呼吸机日和风险呼吸机日。在1，068例住院患者中，106例（23.5%）机械通气患者发生VAP。VAP首次发作的发生率为22.8/1000患者-天（95%CI 18.7-27.6），29.6/1000患者-天（24.2-35.8），35.7/1000呼吸机-天（29.2-43.2）和44.0/1000呼吸机-天（36.0-53.2）。当考虑所有VAP发作时（n=127），感染率为27.3次发作/1，000 ICU患者日（95% CI 22.6-32.1）和42.8次发作/1，000呼吸机日（35.3-50.2）。结论.报告VAP发生率的方法对风险估计有重大影响。因此，负责病人护理政策的临床医生和医院管理人员应该知道如何阅读和比较医院感染率。
Objective. To determine the influence of using different denominators on risk estimates of ventilator-associated pneumonia (VAP). Design and setting. Prospective cohort study in the medical ICU of a large teaching hospital. Patients. All consecutive patients admitted for more than 48 h between October 1995 and November 1997.Measurements and results. We recorded all ICU-acquired infections using modified CDC criteria. VAP rates were reported per 1,000 patient-days, patient-days at risk, ventilator-days, and ventilator-days at risk. Of the 1,068 patients admitted, VAP developed in 106 (23.5%) of those mechanically ventilated. The incidence of the first episode of VAP was 22.8 per 1,000 patient-days (95% CI 18.7-27.6), 29.6 per 1,000 patient-days at risk (24.2-35.8), 35.7 per 1,000 ventilator-days (29.2-43.2), and 44.0 per 1,000 ventilator-days at risk (36.0-53.2). When considering all episodes of VAP (n=127), infection rates were 27.3 episodes per 1,000 ICU patient-days (95% CI 22.6-32.1) and 42.8 episodes per 1,000 ventilator-days (35.3-50.2). Conclusions. The method of reporting VAP rates has a significant impact on risk estimates. Accordingly, clinicians and hospital management in charge of patient-care policies should be aware of how to read and compare nosocomial infection rates.