SESSION TITLE: ICU Infections
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 27, 2014 at 01:30 PM - 02:30 PM
PURPOSE: Ventilator Associated Pneumonia (VAP) is an important cause of morbidity and mortality in hospitalized patients requiring mechanical ventilation. While several risk factors like chronic lung disease (CLD), and altered level of consciousness (ALC) have been associated with higher incidence of VAP, role of epidemiological factors in development of VAP is largely unknown.
METHODS: We queried the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) between 2008 and 2011 using the ICD-9 procedure code of 96.70, 96.71 and 96.72 for mechanical ventilation. The patients who developed VAP were identified by ICD9- diagnosis code of 997.31. Severity of co-morbidities was determined using Deyo modification of Charlson co-morbidity index (CCI). Using SAS 9.2, Survey procedures were used to identify multivariate predictors for development of VAP (by logistic regression model), accommodating hierarchical two stage cluster design of NIS.
RESULTS: A total of 905,035 patients (Weighted N = 4,466,028) who required mechanical ventilation were available for analysis, out of which 13,082 developed VAP (Weighted N = 64,469). After controlling for confounders (Age, CLD, ALC, ARDS, NG Tube, Aspiration, Co-morbid conditions, chest surgery, hospital characteristics, insurance status), the independent predictors for development of VAP were mechanical ventilation for more than 96 hours (OR 13.64, 95% CI 12.56 - 14.81, p<0.001), male gender (OR 1.33, 95% CI 1.27 - 1.39, p<0.001), black race (OR 1.23, 95% CI 1.07 - 1.41, p=0.007), and teaching hospital status (OR 1.64, 95% CI 1.36 - 1.97, p<0.001).
CONCLUSIONS: Our study provides analysis of one of the largest sample of patients on mechanical ventilation. While requirement of mechanical ventilation more than 96 hours is the strongest predictor of development of VAP, black race, male gender and teaching hospital were also associated with higher odds of development of VAP.
CLINICAL IMPLICATIONS: In addition to known risk factors, the African Americans and males are at higher risk of developing VAP. The, at risk population, may require higher suspicion for VAP for early diagnoses and treatment of VAP in addition to aggressive measures to prevent VAP.
DISCLOSURE: The following authors have nothing to disclose: Kathan Mehta, Ronak Soni, Tapan Mehta, Khushboo Sheth, Zeeshan Mansuri, Longjian Liu
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