title: Nosocomial pneumonia in non-invasive ventilation patients: incidence, characteristics, and outcomes.
abstract: BACKGROUND
  Nosocomial pneumonia occasionally occurs in non-invasive ventilation (NIV) patients.
  
  
  OBJECTIVE
  To report the incidence, characteristics, and outcomes of nosocomial pneumonia in NIV patients.
  
  
  METHODS
  A prospective observational study was performed in a respiratory intensive care unit (ICU). After admission, patients who received NIV for more than 48 h were enrolled. Pneumonia was considered nosocomial when it occurred after at least 48 h of NIV.
  
  
  RESULTS
  Between January 2012 and August 2014, we enrolled 520 NIV patients. Nosocomial pneumonia occurred in 16 patients (3.1%). The nosocomial pneumonia rate was 4.5 cases per 1000 NIV-days. The most common pathogen was Acinetobacter baumannii (81%). At the initiation of NIV, there were no differences in age, gender, diagnosis, disease severity, or arterial blood gas findings between patients with and without nosocomial pneumonia. Compared to patients without nosocomial pneumonia, nosocomial pneumonia patients had a longer duration of NIV (8.4 vs 5.0 days, P < 0.01), a longer ICU stay (10.8 vs 7.9 days, P = 0.01), a longer hospital stay (25.9 vs 15.3 days, P = 0.04), a higher intubation rate (63% vs 21%, P < 0.01), and higher hospital mortality (75% vs 25%, P < 0.01). Nosocomial pneumonia was an independent risk factor for intubation (OR: 6.74; 95% CI: 2.24-20.28) and death (7.65; 1.34-43.72).
  
  
  CONCLUSIONS
  The incidence of nosocomial pneumonia in NIV patients in this population was 3.1%. Nosocomial pneumonia increased the time that NIV was required, length of ICU stay, length of hospital stay, intubation rate, and hospital mortality.
authors.affiliation: Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Zuli
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: duanjun412589@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Duan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects*; D011014:Pneumonia / Q000453:epidemiology* / Q000473:pathology*; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000473:pathology*; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hospital mortality; ICU stay; Intubation; Non-invasive ventilation; Nosocomial pneumonia; Pneumonia