title: Incidence, risk factors, and outcome of ventilator-associated pneumonia.
abstract: OBJECTIVE
  The purpose of this study is to determine the incidence, risk factors, and outcome of ventilator-associated pneumonia (VAP).
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Three hundred sixty-one intensive care units (ICUs) from 20 countries.
  
  
  METHODS
  Two thousand eight hundred ninety-seven patients mechanically ventilated for more than 12 hours.
  
  
  RESULTS
  Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple organ failure over the course of mechanical ventilation, and outcome were collected. Ventilator-associated pneumonia was present in 439 patients (15%). Patients with VAP were more likely to have chronic pulmonary obstructive disease, aspiration, sepsis, and acute respiratory distress syndrome. Mortality in patients with VAP was 38%. Factors associated with mortality were severity of illness, limited activity before the onset of mechanical ventilation and development of shock, acute renal failure, and worsening of hypoxemia during the period of mechanical ventilation. Case-control analysis showed no increased mortality in patients with VAP (38.1% vs 37.9%, P = .95) but prolonged duration of mechanical ventilation and ICU stay.
  
  
  CONCLUSIONS
  In a large cohort of mechanically ventilated patients, VAP is more likely in patients with underlying lung disease (acute or chronic). Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay but no increase in mortality.
authors.affiliation: Intensive Care Unit, Hospital Universitario de Getafe, 28905-Getafe, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Tejerina
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Fernando
authors.initials: F
authors.lastname: Palizas
authors.forename: Marco
authors.initials: M
authors.lastname: González
authors.forename: Gabriel
authors.initials: G
authors.lastname: D'Empaire
authors.forename: Carlos
authors.initials: C
authors.lastname: Apezteguía
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors