Staff View: Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)

Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)

Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those ofhigh-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs.Design: Prospective cohort study.Setting: This stu...

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Main Authors:	ROSENTHAL, VICTOR DANIEL, Jin, Zhilin, Memish, Ziad A., Rodrigues, Camilla Rodrigues, Myatra, Sheila Nainan, Kharbanda, Mohit, Valderrama-Beltran, Sandra Liliana, Mehta, Yatin, Daboor, Mohammad Abdellatif, Todi, Subhash Kumar, Aguirre-Avalos, Guadalupe, Guclu, Ertugrul, Gan, Chin Seng, Alvarez, Luisa Fernanda Jiménez, Chawla, Rajesh, Hlinkova, Sona, Arjun, Rajalakshmi, Agha, Hala Mounir, Chavarria, Maria Adelia Zuniga, Davaadagva, Narangarav, Mat Nor, Mohd Basri, Gomez, Katherine, Moros, Daisy Aguilar De, Tai, Chian-Wern, Gonzalez, Alejandro Sassoe, Moreno, Lina Alejandra Aguilar, Sandhu, Kavita, Janc, Jarosław, Bocanegra, Mary Cruz Aleman, Yildizdas, Dincer, Medina, Yuliana Andrea Cano, Mota, Maria Isabel Villegas, Omar, Abeer Aly, Duszynska, Wieslawa, BelKebir, Souad, El-Kholy, Amani Ali, Alkhawaja, Safaa Abdulaziz, Florin, George Horhat, Medeiros, Eduardo Alexandrino, Tao, Lili, Tumu, Nellie, Elanbya, May Gamar, Dongol, Reshma, Mioljević, Vesna, Raka, Lul, Dueñas, Lourdes, Carreazo, Nilton Yhuri, Dendane, Tarek, Ikram, Aamer, Kanj, Souha S., Petrov, Michael M., Bouziri, Asma, Hung, Nguyen Viet, Belskiy, Vladislav, Elahi, Naheed, Bovera, María Marcela, Yin, Ruijie
Format:	Article
Language:	English English
Published:	Cambridge University Press 2023
Subjects:	RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
Online Access:	http://irep.iium.edu.my/104372/2/104372_Multinational%20prospective%20cohort%20study%20of%20rates%20and%20risk%20factors.pdf http://irep.iium.edu.my/104372/4/104372_Multinational%20prospective%20cohort%20study%20of%20rates%20and%20risk%20factors%20_Scopus.pdf http://irep.iium.edu.my/104372/ https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/multinational-prospective-cohort-study-of-rates-and-risk-factors-for-ventilatorassociated-pneumonia-over-24-years-in-42-countries-of-asia-africa-eastern-europe-latin-america-and-the-middle-east-findings-of-the-international-nosocomial-infection-control-consortium-inicc/894F709A0109485722E01C96B21DB866 https://doi.org/10.1017/ash.2022.339
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id	my.iium.irep.104372
record_format	dspace
institution	Universiti Islam Antarabangsa Malaysia
building	IIUM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	International Islamic University Malaysia
content_source	IIUM Repository (IREP)
url_provider	http://irep.iium.edu.my/
language	English English
topic	RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
spellingShingle	RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid ROSENTHAL, VICTOR DANIEL Jin, Zhilin Memish, Ziad A. Rodrigues, Camilla Rodrigues Myatra, Sheila Nainan Kharbanda, Mohit Valderrama-Beltran, Sandra Liliana Mehta, Yatin Daboor, Mohammad Abdellatif Todi, Subhash Kumar Aguirre-Avalos, Guadalupe Guclu, Ertugrul Gan, Chin Seng Alvarez, Luisa Fernanda Jiménez Chawla, Rajesh Hlinkova, Sona Arjun, Rajalakshmi Agha, Hala Mounir Chavarria, Maria Adelia Zuniga Davaadagva, Narangarav Mat Nor, Mohd Basri Gomez, Katherine Moros, Daisy Aguilar De Tai, Chian-Wern Gonzalez, Alejandro Sassoe Moreno, Lina Alejandra Aguilar Sandhu, Kavita Janc, Jarosław Bocanegra, Mary Cruz Aleman Yildizdas, Dincer Medina, Yuliana Andrea Cano Mota, Maria Isabel Villegas Omar, Abeer Aly Duszynska, Wieslawa BelKebir, Souad El-Kholy, Amani Ali Alkhawaja, Safaa Abdulaziz Florin, George Horhat Medeiros, Eduardo Alexandrino Tao, Lili Tumu, Nellie Elanbya, May Gamar Dongol, Reshma Mioljević, Vesna Raka, Lul Dueñas, Lourdes Carreazo, Nilton Yhuri Dendane, Tarek Ikram, Aamer Kanj, Souha S. Petrov, Michael M. Bouziri, Asma Hung, Nguyen Viet Belskiy, Vladislav Elahi, Naheed Bovera, María Marcela Yin, Ruijie Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)
description	Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those ofhigh-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs.Design: Prospective cohort study.Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and MiddleEastern countries.Participants: The study included patients admitted to ICUs across 24 years.Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent var-iables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidenceinterval [CI], 1.16–1.28; P<.0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P<.0001);mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23–1.31; P<.0001); continuous positive airway pressure (CPAP), whichwas associated with the highest risk (aOR, 13.38; 95% CI, 11.57–15.48; P<.0001); tracheostomy connected to a MV, which was associated withthe next-highest risk (aOR, 8.31; 95% CI, 7.21–9.58; P<.0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34–7.21;P<.0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17–1.29; P<.0001); admission to a public hospital (aOR, 1.59; 95% CI,1.35-1.86; P<.0001); middle-income country (aOR, 1.22; 95% CI, 15–1.29; P<.0001); admission to an adult-oncology ICU, which wasassociated with the highest risk (aOR, 4.05; 95% CI, 3.22–5.09; P<.0001), admission to a neurologic ICU, which was associated withthe next-highest risk (aOR, 2.48; 95% CI, 1.78–3.45; P<.0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79–3.07;P<.0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51–0.77; P<.0001).Conclusions: Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country incomelevel. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use andimplementing a set of evidence-based VAP prevention recommendations.
format	Article
author	ROSENTHAL, VICTOR DANIEL Jin, Zhilin Memish, Ziad A. Rodrigues, Camilla Rodrigues Myatra, Sheila Nainan Kharbanda, Mohit Valderrama-Beltran, Sandra Liliana Mehta, Yatin Daboor, Mohammad Abdellatif Todi, Subhash Kumar Aguirre-Avalos, Guadalupe Guclu, Ertugrul Gan, Chin Seng Alvarez, Luisa Fernanda Jiménez Chawla, Rajesh Hlinkova, Sona Arjun, Rajalakshmi Agha, Hala Mounir Chavarria, Maria Adelia Zuniga Davaadagva, Narangarav Mat Nor, Mohd Basri Gomez, Katherine Moros, Daisy Aguilar De Tai, Chian-Wern Gonzalez, Alejandro Sassoe Moreno, Lina Alejandra Aguilar Sandhu, Kavita Janc, Jarosław Bocanegra, Mary Cruz Aleman Yildizdas, Dincer Medina, Yuliana Andrea Cano Mota, Maria Isabel Villegas Omar, Abeer Aly Duszynska, Wieslawa BelKebir, Souad El-Kholy, Amani Ali Alkhawaja, Safaa Abdulaziz Florin, George Horhat Medeiros, Eduardo Alexandrino Tao, Lili Tumu, Nellie Elanbya, May Gamar Dongol, Reshma Mioljević, Vesna Raka, Lul Dueñas, Lourdes Carreazo, Nilton Yhuri Dendane, Tarek Ikram, Aamer Kanj, Souha S. Petrov, Michael M. Bouziri, Asma Hung, Nguyen Viet Belskiy, Vladislav Elahi, Naheed Bovera, María Marcela Yin, Ruijie
author_facet	ROSENTHAL, VICTOR DANIEL Jin, Zhilin Memish, Ziad A. Rodrigues, Camilla Rodrigues Myatra, Sheila Nainan Kharbanda, Mohit Valderrama-Beltran, Sandra Liliana Mehta, Yatin Daboor, Mohammad Abdellatif Todi, Subhash Kumar Aguirre-Avalos, Guadalupe Guclu, Ertugrul Gan, Chin Seng Alvarez, Luisa Fernanda Jiménez Chawla, Rajesh Hlinkova, Sona Arjun, Rajalakshmi Agha, Hala Mounir Chavarria, Maria Adelia Zuniga Davaadagva, Narangarav Mat Nor, Mohd Basri Gomez, Katherine Moros, Daisy Aguilar De Tai, Chian-Wern Gonzalez, Alejandro Sassoe Moreno, Lina Alejandra Aguilar Sandhu, Kavita Janc, Jarosław Bocanegra, Mary Cruz Aleman Yildizdas, Dincer Medina, Yuliana Andrea Cano Mota, Maria Isabel Villegas Omar, Abeer Aly Duszynska, Wieslawa BelKebir, Souad El-Kholy, Amani Ali Alkhawaja, Safaa Abdulaziz Florin, George Horhat Medeiros, Eduardo Alexandrino Tao, Lili Tumu, Nellie Elanbya, May Gamar Dongol, Reshma Mioljević, Vesna Raka, Lul Dueñas, Lourdes Carreazo, Nilton Yhuri Dendane, Tarek Ikram, Aamer Kanj, Souha S. Petrov, Michael M. Bouziri, Asma Hung, Nguyen Viet Belskiy, Vladislav Elahi, Naheed Bovera, María Marcela Yin, Ruijie
author_sort	ROSENTHAL, VICTOR DANIEL
title	Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)
title_short	Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)
title_full	Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)
title_fullStr	Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)
title_full_unstemmed	Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)
title_sort	multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of asia, africa, eastern europe, latin america, and the middle east: findings of the international nosocomial infection control consortium (inicc)
publisher	Cambridge University Press
publishDate	2023
url	http://irep.iium.edu.my/104372/2/104372_Multinational%20prospective%20cohort%20study%20of%20rates%20and%20risk%20factors.pdf http://irep.iium.edu.my/104372/4/104372_Multinational%20prospective%20cohort%20study%20of%20rates%20and%20risk%20factors%20_Scopus.pdf http://irep.iium.edu.my/104372/ https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/multinational-prospective-cohort-study-of-rates-and-risk-factors-for-ventilatorassociated-pneumonia-over-24-years-in-42-countries-of-asia-africa-eastern-europe-latin-america-and-the-middle-east-findings-of-the-international-nosocomial-infection-control-consortium-inicc/894F709A0109485722E01C96B21DB866 https://doi.org/10.1017/ash.2022.339
_version_	1762961314602287104
spelling	my.iium.irep.1043722023-04-11T06:09:22Z http://irep.iium.edu.my/104372/ Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC) ROSENTHAL, VICTOR DANIEL Jin, Zhilin Memish, Ziad A. Rodrigues, Camilla Rodrigues Myatra, Sheila Nainan Kharbanda, Mohit Valderrama-Beltran, Sandra Liliana Mehta, Yatin Daboor, Mohammad Abdellatif Todi, Subhash Kumar Aguirre-Avalos, Guadalupe Guclu, Ertugrul Gan, Chin Seng Alvarez, Luisa Fernanda Jiménez Chawla, Rajesh Hlinkova, Sona Arjun, Rajalakshmi Agha, Hala Mounir Chavarria, Maria Adelia Zuniga Davaadagva, Narangarav Mat Nor, Mohd Basri Gomez, Katherine Moros, Daisy Aguilar De Tai, Chian-Wern Gonzalez, Alejandro Sassoe Moreno, Lina Alejandra Aguilar Sandhu, Kavita Janc, Jarosław Bocanegra, Mary Cruz Aleman Yildizdas, Dincer Medina, Yuliana Andrea Cano Mota, Maria Isabel Villegas Omar, Abeer Aly Duszynska, Wieslawa BelKebir, Souad El-Kholy, Amani Ali Alkhawaja, Safaa Abdulaziz Florin, George Horhat Medeiros, Eduardo Alexandrino Tao, Lili Tumu, Nellie Elanbya, May Gamar Dongol, Reshma Mioljević, Vesna Raka, Lul Dueñas, Lourdes Carreazo, Nilton Yhuri Dendane, Tarek Ikram, Aamer Kanj, Souha S. Petrov, Michael M. Bouziri, Asma Hung, Nguyen Viet Belskiy, Vladislav Elahi, Naheed Bovera, María Marcela Yin, Ruijie RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those ofhigh-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs.Design: Prospective cohort study.Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and MiddleEastern countries.Participants: The study included patients admitted to ICUs across 24 years.Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent var-iables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidenceinterval [CI], 1.16–1.28; P<.0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P<.0001);mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23–1.31; P<.0001); continuous positive airway pressure (CPAP), whichwas associated with the highest risk (aOR, 13.38; 95% CI, 11.57–15.48; P<.0001); tracheostomy connected to a MV, which was associated withthe next-highest risk (aOR, 8.31; 95% CI, 7.21–9.58; P<.0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34–7.21;P<.0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17–1.29; P<.0001); admission to a public hospital (aOR, 1.59; 95% CI,1.35-1.86; P<.0001); middle-income country (aOR, 1.22; 95% CI, 15–1.29; P<.0001); admission to an adult-oncology ICU, which wasassociated with the highest risk (aOR, 4.05; 95% CI, 3.22–5.09; P<.0001), admission to a neurologic ICU, which was associated withthe next-highest risk (aOR, 2.48; 95% CI, 1.78–3.45; P<.0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79–3.07;P<.0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51–0.77; P<.0001).Conclusions: Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country incomelevel. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use andimplementing a set of evidence-based VAP prevention recommendations. Cambridge University Press 2023-01-09 Article PeerReviewed application/pdf en http://irep.iium.edu.my/104372/2/104372_Multinational%20prospective%20cohort%20study%20of%20rates%20and%20risk%20factors.pdf application/pdf en http://irep.iium.edu.my/104372/4/104372_Multinational%20prospective%20cohort%20study%20of%20rates%20and%20risk%20factors%20_Scopus.pdf ROSENTHAL, VICTOR DANIEL and Jin, Zhilin and Memish, Ziad A. and Rodrigues, Camilla Rodrigues and Myatra, Sheila Nainan and Kharbanda, Mohit and Valderrama-Beltran, Sandra Liliana and Mehta, Yatin and Daboor, Mohammad Abdellatif and Todi, Subhash Kumar and Aguirre-Avalos, Guadalupe and Guclu, Ertugrul and Gan, Chin Seng and Alvarez, Luisa Fernanda Jiménez and Chawla, Rajesh and Hlinkova, Sona and Arjun, Rajalakshmi and Agha, Hala Mounir and Chavarria, Maria Adelia Zuniga and Davaadagva, Narangarav and Mat Nor, Mohd Basri and Gomez, Katherine and Moros, Daisy Aguilar De and Tai, Chian-Wern and Gonzalez, Alejandro Sassoe and Moreno, Lina Alejandra Aguilar and Sandhu, Kavita and Janc, Jarosław and Bocanegra, Mary Cruz Aleman and Yildizdas, Dincer and Medina, Yuliana Andrea Cano and Mota, Maria Isabel Villegas and Omar, Abeer Aly and Duszynska, Wieslawa and BelKebir, Souad and El-Kholy, Amani Ali and Alkhawaja, Safaa Abdulaziz and Florin, George Horhat and Medeiros, Eduardo Alexandrino and Tao, Lili and Tumu, Nellie and Elanbya, May Gamar and Dongol, Reshma and Mioljević, Vesna and Raka, Lul and Dueñas, Lourdes and Carreazo, Nilton Yhuri and Dendane, Tarek and Ikram, Aamer and Kanj, Souha S. and Petrov, Michael M. and Bouziri, Asma and Hung, Nguyen Viet and Belskiy, Vladislav and Elahi, Naheed and Bovera, María Marcela and Yin, Ruijie (2023) Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC). Antimicrobial Stewardship & Healthcare Epidemiology, 3 (1). pp. 1-10. ISSN 2735-4977 E-ISSN 2735-4985 https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/multinational-prospective-cohort-study-of-rates-and-risk-factors-for-ventilatorassociated-pneumonia-over-24-years-in-42-countries-of-asia-africa-eastern-europe-latin-america-and-the-middle-east-findings-of-the-international-nosocomial-infection-control-consortium-inicc/894F709A0109485722E01C96B21DB866 https://doi.org/10.1017/ash.2022.339
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Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)

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