Study objectives: To prospectively identify the
occurrence of ventilator-associated pneumonia (VAP) in a community
hospital, and to determine the risk factors for VAP and the influence
of VAP on patient outcomes in a nonteaching institution.
Design: Prospective cohort study.
A medical ICU and a surgical ICU in a 500-bed private community
nonteaching hospital: Missouri Baptist Hospital.
Patients: Between March 1998 and December 1999, all
patients receiving mechanical ventilation who were admitted to the ICU
setting were prospectively evaluated.
Prospective patient surveillance and data collection.
Results: During a 22-month period, 3,171 patients were
admitted to the medical and surgical ICUs. Eight hundred eighty
patients (27.8%) received mechanical ventilation. VAP developed in 132
patients (15.0%) receiving mechanical ventilation. Three hundred one
patients (34.2%) who received mechanical ventilation died during
hospitalization. Logistic regression analysis demonstrated that
tracheostomy (adjusted odds ratio [AOR], 6.71; 95% confidence
interval [CI], 3.91 to 11.50; p < 0.001), multiple central venous
line insertions (AOR, 4.20; 95% CI, 2.72 to 6.48; p < 0.001),
reintubation (AOR, 2.88; 95% CI, 1.78 to 4.66; p < 0.001), and the
use of antacids (AOR, 2.81; 95% CI, 1.19 to 6.64; p = 0.019)
were independently associated with the development of VAP. The hospital
mortality of patients with VAP was significantly greater than the
mortality of patients without VAP (45.5% vs 32.2%, respectively;
p = 0.004). The occurrence of bacteremia, compromised immune system,
higher APACHE (acute physiology and chronic health evaluation) II
scores, and older age were identified as independent predictors of
Conclusions: These data suggest
that VAP is a common nosocomial infection in the community hospital
setting. The risk factors for the development of VAP and risk factors
for hospital mortality in a community hospital are similar to those
identified from university-affiliated hospitals. These risk factors can
potentially be employed to develop local strategies for the prevention
Clinical implications: ICU clinicians should
be aware of the risk factors associated with the development of VAP and
the impact of VAP on clinical outcomes. More importantly, they should
cooperate in the development of local multidisciplinary strategies
aimed at the prevention of VAP and other nosocomial