title: Incidence and attributable costs of ventilator-associated pneumonia (VAP) in a tertiary-level intensive care unit (ICU) in northern India.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in the intensive care unit (ICU). However, the economic effects of such infections remain unclear particularly in developing countries.
  
  
  METHODS
  Patients who were mechanically ventilated for more than 48 h in the ICU were studied for the occurrence of VAP. Total drug costs and hospital costs were noted, and attributable costs were calculated after adjusting for potential confounders.
  
  
  RESULTS
  Ninety-five (38%) patients who were ventilated for more than 48 h developed VAP, which resulted in an incidence of 40.1 VAP infections/1000 mechanical ventilation days. The patients with VAP experienced significantly longer hospital stay [21 (IQ = 14-33) days versus 11 (IQ = 6-18) days, P < 0.0001)] and incurred greater hospital costs [USD $6250.92 (IQ = 3525.39-9667.57) versus $2598.84 (IQ = 1644.33-4477.65), P < 0.0001]. Multiple regression analysis revealed that the cost-driving factors in our study population were the occurrence of VAP infections (P < 0.0001) and the duration of hospital stay (P < 0.0001). The attributable cost of VAP infection was calculated to be USD $5200 (95% CI = 3245-7152).
  
  
  CONCLUSIONS
  We conclude that VAP significantly increases the costs of treatment in low-income developing countries. This study highlights the need to implement urgent measures to reduce the incidence of this disease in ICUs.
authors.affiliation: Department of Anaesthesiology and Critical Care, Christian Medical College, Ludhiana 141008, Punjab, India. Electronic address: ashusatish.thomas@gmail.com.
authors.forename: Ashu Sara
authors.initials: AS
authors.lastname: Mathai
authors.affiliation: Department of Anaesthesiology and Critical Care, Christian Medical College, Ludhiana 141008, Punjab, India. Electronic address: atulphillips@yahoo.co.in.
authors.forename: Atul
authors.initials: A
authors.lastname: Phillips
authors.affiliation: Department of Community Medicine, Christian Medical College, Ludhiana 141008, Punjab, India. Electronic address: kaurparmdeep@yahoo.com.
authors.forename: Paramdeep
authors.initials: P
authors.lastname: Kaur
authors.affiliation: Department of Community Medicine, Christian Medical College, Ludhiana 141008, Punjab, India. Electronic address: rajeshisaac@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Isaac
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000191:economics* / Q000453:epidemiology*; D011446:Prospective Studies
keywords: Attributable costs; Intensive care unit; Ventilator-associated pneumonia