The occurrence of ventilator-associated pneumonia in a community hospital - Risk factors and clinical outcomes

Study objectives: To prospectively identify the occurrence of ventilator-as sociated pneumonia (VAP) in a community hospital, and to determine the risk factors for VAP and the influence of VAP on patient outcomes in a nonteach ing institution. Design. Prospective cohort study. Setting: A medical ICU and a surgical ICU in a 500-bed private community no nteaching hospital: Missouri Baptist Hospital. Patients: Between March 1998 and December 1999, all patients receiving mech anical ventilation who were admitted to the ICU setting were prospectively evaluated. Intervention. Prospective patient surveillance and data collection. Results. During a 22-month period, 3,171 patients were admitted to the medi cal and surgical ICUs. Eight hundred eighty patients (27.8%) received mecha nical ventilation. VAP developed in 132 patients (15.0%) receiving mechanic al ventilation. Three hundred one patients (34.2%) who received mechanical ventilation died during hospitalization. Logistic regression analysis demon strated that tracheostomy (adjusted odds ratio [AOR], 6.71; 95% confidence interval [CI], 3.91 to 11.50; p < 0.001), multiple central venous line inse rtions (AOR, 4.20; 95% CI, 2.72 to 6.48; p < 0.001), reintubation (AOR, 2.8 8; 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 devel opment of VAP. The hospital mortality of patients with VAP was significantl y greater than the mortality of patients without VAP (45.5% vs 32.2%, respe ctively; p = 0.004). The occurrence of bacteremia, compromised immune syste m, higher APACHE (acute physiology and chronic health evaluation) II scores , and older age were identified as independent predictors of hospital morta lity. Conclusions: These data suggest that VAP is a common nosocomial infection i n the community hospital setting. The risk factors for the development of V AP and risk factors for hospital mortality in a community hospital are simi lar to those identified from university-affiliated hospitals. These risk fa ctors can potentially be employed to develop local strategies for the preve ntion of VAP. Clinical implications: ICU clinicians should be aware of the risk factors associated with the development of VAP and the impact of VAP o n clinical outcomes. More importantly, they should cooperate in the develop ment of local multidisciplinary strategies aimed at the prevention of VAP a nd other nosocomial infections.