title: Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study.
abstract: BACKGROUND
  The incidence of ventilator-associated pneumonia (VAP) within the first 48 hours of intensive care unit (ICU) stay has been poorly investigated. The objective was to estimate early-onset VAP occurrence in ICUs within 48 hours after admission.
  
  
  METHODS
  We analyzed data from prospective surveillance between 01/01/2001 and 31/12/2009 in 11 ICUs of Lyon hospitals (France). The inclusion criteria were: first ICU admission, not hospitalized before admission, invasive mechanical ventilation during first ICU day, free of antibiotics at admission, and ICU stay ≥ 48 hours. VAP was defined according to a national protocol. Its incidence was the number of events per 1,000 invasive mechanical ventilation-days. The Poisson regression model was fitted from day 2 (D2) to D8 to incident VAP to estimate the expected VAP incidence from D0 to D1 of ICU stay.
  
  
  RESULTS
  Totally, 367 (10.8%) of 3,387 patients in 45,760 patient-days developed VAP within the first 9 days. The predicted cumulative VAP incidence at D0 and D1 was 5.3 (2.6-9.8) and 8.3 (6.1-11.1), respectively. The predicted cumulative VAP incidence was 23.0 (20.8-25.3) at D8. The proportion of missed VAP within 48 hours from admission was 11% (9%-17%).
  
  
  CONCLUSIONS
  Our study indicates underestimation of early-onset VAP incidence in ICUs, if only VAP occurring ≥ 48 hours are considered to be hospital-acquired. Clinicians should be encouraged to develop a strategy for early detection after ICU admission.
authors: Hospices Civils de Lyon, Infection Control Unit, Edouard Herriot Hospital, Lyon, France. philippe.vanhems@chu-lyon.fr
authors: Philippe
authors: P
authors: Vanhems
authors: Thomas
authors: T
authors: Bénet
authors: Nicolas
authors: N
authors: Voirin
authors: Jean-Marie
authors: JM
authors: Januel
authors: Alain
authors: A
authors: Lepape
authors: Bernard
authors: B
authors: Allaouchiche
authors: Laurent
authors: L
authors: Argaud
authors: Dominique
authors: D
authors: Chassard
authors: Claude
authors: C
authors: Guérin
authors: Jean-Jacques
authors: JJ
authors: Lehot
authors: Marc-Olivier
authors: MO
authors: Robert
authors: Gérard
authors: G
authors: Fournier
authors: Didier
authors: D
authors: Jacques
authors: François
authors: F
authors: Artru
authors: Pierre-Yves
authors: PY
authors: Gueugniaud
authors: Dominique
authors: D
authors: Chassard
authors: Raphaëlle
authors: R
authors: Girard
authors: Jean-Charles
authors: JC
authors: Cêtre
authors: Marie-Christine
authors: MC
authors: Nicolle
authors: Marie-Hélène
authors: MH
authors: Metzger
authors: Jacqueline
authors: J
authors: Grando
mesh_terms: D000328:Adult; D000368:Aged; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008875:Middle Aged; D015233:Models, Statistical; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D011446:Prospective Studies