Trends and Factors Associated With Ventilator-Associated Pneumonia: A National Perspective

Abstract

Background: Ventilator-associated pneumonia (VAP) is a hospital-acquired pneumonia that occurs more than 48 hours after mechanical ventilation. Studies showing temporal trends, predictors, and outcomes of VAP are very limited.Objective: We used the National database to delineate the trends and predictors of VAP from 2009 to 2017.Methods: We analyzed data from the Nationwide Inpatient Sample (NIS) for adult hospitalizations who received mechanical ventilation (MV) by using ICD-9/10-CM procedures codes. We excluded hospitalizations with length of stay (LOS) less than two days. VAP and other diagnoses of interest were identified by ICD-9/10-CM diagnosis codes. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze the data.Results: Out of a total of 5,155,068 hospitalizations who received mechanical ventilation, 93,432 (1.81%) developed VAP. Incidence of VAP decreased from 20/1000 in 2008 to 17/1000 in 2017 with a 5% decrease. Patients who developed VAP had lower mean age (59 vs 61; p<0.001) and higher LOS (25 days vs. 12 days; p<0.001). In multivariable regression analysis, we identified that males, African Americans, teaching hospitals and co-morbidities like neurological disorders, pulmonary circulation disorders and electrolyte disorders are associated with the increased odds of developing VAP. VAP was also associated with higher rates of discharge to facilities and increased LOS.Conclusion: Our study identified the trends along with the risk predictors of VAP in MV patients. Our goal is to lay the foundation for further in-depth analysis of this trend for better risk stratification and development of preventive strategies to reduce the incidence of VAP among MV patients.

Dopamine promotesKlebsiella quasivariicolaproliferation and inflammatory response in the presence of macrophages

“…Diagram of the Animal Experiment Plan. (B) The mice were randomly divided into four groups: (1) control group (CON), (2) dopamine group (DA), (3) K. quasivariicola group (K.q), and (4) dopamine + K. quasivariicola group (K.q+DA). The control group received a saline intraperitoneal injection.…”

“…All animal experiments were approved by the Committee on the Ethics of Animal Experiments of Dalian Medical University (Permission number: SYXK (Liao) 2018-0007) and were performed in strict accordance with the recommendations. Sixteen C57/BL6 mice (aged 8 weeks, weight 20-25 g) were randomly divided into four experimental groups: (1) control group (CON), (2) dopamine group (DA), (3) K. quasivariicola group (k.q), and (4) K. quasivariicola + dopamine group (k.q+DA). In control group, the mice were intraperitoneal injection with saline.…”

“…It can cause the increase hospitalization time, risk of complications, and also the additional financial burdens on patients (1). The risk factors of nosocomial infection include the use of invasive treatment, the administration of hormones and antibiotics (2, 3). In addition, recently, examples have been reported that dopamine, a commonly used drug in ICU, was also associated with infections.…”

Risk Factors Associated with Mortality in Acinetobacter baumannii Infections: Results of a Prospective Cohort Study in a Tertiary Public Hospital in Guayaquil, Ecuador

“…The chosen Intensive Care Units have added new endotracheal tubes covered with silver sulfate or with modified sleeves to avoid aspiration and secretion drainage through continuous or intermittent subglottic vias. There are also new devices to eliminate the biofilm from the endotracheal tube, to apply saline solution before suction, and to perform early tracheostomy [ 38 , 39 ].…”

Dopamine promotes Klebsiella quasivariicola proliferation and inflammatory response in the presence of macrophages

“…Nosocomial infections present a formidable challenge within intensive care units (ICU), leading to prolonged hospitalization, heightened risk of complications, and increased financial burdens on patients (Leone et al, 2018). The risk factors for nosocomial infection include the use of invasive treatments, the administration of hormones, and antibiotics (Shah et al, 2022;Yang et al, 2022). Notably, recent reports have raised concerns regarding the potential association between dopamine, a commonly administered drug in ICUs, and an increased risk of infection.…”