title: Ventilator-associated pneumonia in the home care setting.
abstract: OBJECTIVE
  To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University-affiliated home care service.
  
  
  METHODS
  Patients receiving mechanical ventilation at home from June 1995 through December 2001.
  
  
  RESULTS
  Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean +/- SD, 890.6 +/- 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (+/-SD) of 245 +/- 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia.
  
  
  CONCLUSIONS
  Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI 48109, USA. cchenow@umich.edu
authors.forename: Carol E
authors.initials: CE
authors.lastname: Chenoweth
authors.forename: Laraine L
authors.initials: LL
authors.lastname: Washer
authors.forename: Kumari
authors.initials: K
authors.lastname: Obeyesekera
authors.forename: Candace
authors.initials: C
authors.lastname: Friedman
authors.forename: Karolyn
authors.initials: K
authors.lastname: Brewer
authors.forename: Garrett E
authors.initials: GE
authors.lastname: Fugitt
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lark
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006699:Home Care Services; D006701:Home Nursing; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008824:Michigan / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D012189:Retrospective Studies