Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece

Eleni Apostolopoulou, Petros Bakakos, Theophanis Katostaras, Leonides Gregorakos
Respiratory Care 2003, 48 (7): 681-8

INTRODUCTION: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients.

OBJECTIVE: Prospectively identify the factors associated with development of VAP and examine the incidence of VAP.

SUBJECTS: Over a 6-month period we had 175 patients who required mechanical ventilation for longer than 24 hours.

RESULTS: VAP occurred in 56 patients (32%). Stepwise logistic regression analysis identified 5 factors independently associated with VAP (p < 0.05): bronchoscopy (adjusted odds ratio [AOR] = 2.95; 95% confidence interval [CI], 1.1-8.3; p = 0.036); tube thoracostomy (AOR = 2.78; 95% CI, 1.1-6.6; p = 0.023); tracheostomy (AOR = 3.56; 95% CI, 1.7-8.4; p = 0.002); Acute Physiology and Chronic Health Evaluation (APACHE II) score >/= 18 (AOR = 2.33; 95% CI, 1.1-5.1; p = 0.033); and enteral feeding (AOR = 2.89; 95% CI, 1.3-7.7; p = 0.026). The duration of mechanical ventilation was longer among patients who developed VAP (p < 0.001). VAP was not associated with the cause of ICU admission.

CONCLUSIONS: VAP is a common infection and certain interventions might affect the incidence of VAP. ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP and modifying patient care to minimize the risk of VAP, such as avoiding unnecessary bronchoscopy or modulating enteral feeding.

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