title: Epidemiology and outcomes of ventilator-associated pneumonia in a large US database.
abstract: OBJECTIVE
  To evaluate risk factors for ventilator-associated pneumonia (VAP), as well as its influence on in-hospital mortality, resource utilization, and hospital charges.
  
  
  METHODS
  Retrospective matched cohort study using data from a large US inpatient database.
  
  
  METHODS
  Patients admitted to an ICU between January 1998 and June 1999 who received mechanical ventilation for > 24 h.
  
  
  METHODS
  Risk factors for VAP were examined using crude and adjusted odds ratios (AORs). Cases of VAP were matched on duration of mechanical ventilation, severity of illness on admission (predicted mortality), type of admission (medical, surgical, trauma), and age with up to three control subjects. Mortality, resource utilization, and billed hospital charges were then compared between cases and control subjects.
  
  
  RESULTS
  Of the 9,080 patients meeting study entry criteria, VAP developed in 842 patients (9.3%). The mean interval between intubation, admission to the ICU, hospital admission, and the identification of VAP was 3.3 days, 4.5 days, and 5.4 days, respectively. Identified independent risk factors for the development of VAP were male gender, trauma admission, and intermediate deciles of underlying illness severity (on admission) [AOR, 1.58, 1.75, and 1.47 to 1.70, respectively]. Patients with VAP were matched with 2,243 control subjects without VAP. Hospital mortality did not differ significantly between cases and matched control subjects (30.5% vs 30.4%, p = 0.713). Nevertheless, patients with VAP had a significantly longer duration of mechanical ventilation (14.3 +/- 15.5 days vs 4.7 +/- 7.0 days, p < 0.001), ICU stay (11.7 +/- 11.0 days vs 5.6 +/- 6.1 days, p < 0.001), and hospital stay (25.5 +/- 22.8 days vs 14.0 +/- 14.6 days, p < 0.001). Development of VAP was also associated with an increase of > $40,000 USD in mean hospital charges per patient ($104,983 USD +/- $91,080 USD vs $63,689 USD+/- $75,030 USD, p < 0.001).
  
  
  CONCLUSIONS
  This retrospective matched cohort study, the largest of its kind, demonstrates that VAP is a common nosocomial infection that is associated with poor clinical and economic outcomes. While strategies to prevent the occurrence of VAP may not reduce mortality, they may yield other important benefits to patients, their families, and hospital systems.
authors.affiliation: University Hospital Joan XXIII, University Rovira and Virgili, Tarragona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Ollendorf
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
authors.forename: Montserrat
authors.initials: M
authors.lastname: Vera-Llonch
authors.forename: Lisa
authors.initials: L
authors.lastname: Bellm
authors.forename: Rebecca
authors.initials: R
authors.lastname: Redman
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D015331:Cohort Studies; D003428:Cross Infection / Q000635:transmission*; D016208:Databases, Factual; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000517:prevention & control / Q000635:transmission*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States; D012122:Ventilators, Mechanical / Q000009:adverse effects*