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The Epidemiology of Ventilator-Associated Pneumonia in a Network of Community Hospitals: A Prospective Multicenter Study

Published online by Cambridge University Press:  02 January 2015

Mi Suk Lee ,
Vanessa Walker ,
Luke F. Chen ,
Daniel J. Sexton  and
Deverick J. Anderson
Mi Suk Lee
Affiliation:
Duke Infection Control Outreach Network, Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
Vanessa Walker
Affiliation:
Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
Luke F. Chen
Affiliation:
Duke Infection Control Outreach Network, Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Duke Infection Control Outreach Network, Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
Deverick J. Anderson*
Affiliation:
Duke Infection Control Outreach Network, Division of Infectious Diseases, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
*
DUMC Box 102359, Duke University Medical Center, Durham, NC 27710 ([email protected])
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Abstract

Objective.

To describe the epidemiology of ventilator-associated pneumonia (VAP) in community hospitals.

Design and Setting.

Prospective study in 31 community hospitals from 2007 to 2011.

Methods.

VAP surveillance was performed by infection preventionists using the National Healthcare Safety Network protocol. VAP incidence was reported as number of events per 1,000 ventilator-days. We categorized hospitals into small (<30,000 patient-days/year), medium (30,000–60,000 patient-days/year), and large (>60,000 patient-days/year) groups and compared VAP incidence by hospital size.

Results.

The median VAP incidence was 1.4 (interquartile range, 0.4–2.4), and ventilator utilization ratio (VUR) was 0.33 (0.25–0.47). VAP incidence was higher in small hospitals (2.1) than medium (0.85) or large (0.69) hospitals (P = .03) despite a lower VUR in small hospitals (0.29 vs 0.31 vs 0.44, respectively; P = .01). The median age of 247 VAP cases was 64 (53-73); 136 (55.1%) were female; 142 (57.5%) were Caucasian; 170 (68.8%) were admitted from home. The length of stay and duration of ventilation were 26 (14–42) and 12 (4–21) days, respectively. The pre- and postinfection hospital stays were 8 (3–13) days and 14 (8–30) days, respectively. Data on outcomes were available in 214 cases (86.6%), and 75 (35.0%) cases died during hospitalization. The top 3 pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n = 70, 27.9%), Pseudomonas species (n = 40, 16.3%), and Klebsiella species (n = 34, 13.3%).

Conclusions.

VAP incidence was inversely associated with size of hospital. VAP in community hospitals was frequently caused by MRSA. Importantly, predictors of VAP incidence in tertiary care hospitals such as VUR may not be predictive in community hospitals with few ventilated patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 7 , July 2013 , pp. 657 - 662
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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