Early- and late-onset ventilator-associated pneumonia acquired in the intensive care unit: comparison of risk factors.
OBJECTIVE
To compare risk factors of early- (E) and late-onset (L) ventilator-associated pneumonia (VAP).


METHODS
An epidemiological survey based on a nosocomial infection surveillance program of 11 intensive care units (ICUs) of university teaching hospitals in Lyon, France, was conducted. A total of 7236 consecutive ventilated patients, older than 18 years and hospitalized in ICUs for at least 48 hours, were studied between 1996 and 2002. Data during ICU stay, patient-dependent risk factors, device exposure, nosocomial infections occurrence, and outcome were collected. The cutoff point definition between E-VAP (<or=6 days) and L-VAP (>six days) was based on the daily hazard rate of VAP.


RESULTS
The VAP incidence rate was 13.1%, 356 (37.6%) E-VAP (within 6 days of admission) and 590 (62.4%) L-VAP were reported. Independent risk factor for E-VAP vs L-VAP was surgical diagnostic category (odds ratio [OR], 1.49 [95% confidence interval, 1.07-2.07]), whereas independent risk factors for L-VAP vs E-VAP were older age (OR, 1.01 [1.01-1.02]), high Simplified Acute Physiology Score II (OR, 1.01 [1.00-1.02]), infection on admission (OR=2.22 [1.61-3.03]), another nosocomial infection before VAP (OR, 5.88 [3.33-11.11]), and exposure to central venous catheter before VAP (OR, 4.76 [1.04-20.00]).


CONCLUSIONS
E-VAP and L-VAP have different risk factors, highlighting the need for developing specific preventive measures.
Giard
Marine
M
Laboratory of Epidemiology and Public Health, CNRS UMR 5558, Lyon 1 University, 69008 Lyon, France.
Lepape
Alain
A
Allaouchiche
Bernard
B
Guerin
Claude
C
Lehot
Jean-Jacques
JJ
Robert
Marc-Olivier
MO
Fournier
Gérard
G
Jacques
Didier
D
Chassard
Dominique
D
Gueugniaud
Pierre-Yves
PY
Artru
François
F
Petit
Paul
P
Robert
Dominique
D
Mohammedi
Ismaël
I
Girard
Raphaëlle
R
Cêtre
Jean-Charles
JC
Nicolle
Marie-Christine
MC
Grando
Jacqueline
J
Fabry
Jacques
J
Vanhems
Philippe
P
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents