Epidemiology
and Outcomes of Ventilator-Associated Pneumonia in a Large
U.S. Database
Rello J, Ollendorf DA, et al. Chest. 2002;122:2115-2121.
Objective
To evaluate risk factors for
ventilator-associated pneumonia (VAP), as well as its influence
on in-hospital
mortality, resource utilization, and hospital charges.
Methods
The retrospective matched cohort
study evaluated data from a large U.S. inpatient database.
Patients who were admitted to an ICU and received mechanical
ventilation for >24 hours were
included in the study. Cases of VAP were matched on duration
of mechanical ventilation,
severity of illness on admission, type of admission (medical,
surgical, trauma) and age with up to
three control subjects. Mortality, resource utilization
and billed hospital charges were then
compared between cases and control subjects. Results
Of the 9,080 patients meeting the
study entry criteria, 842 patients developed VAP (9.3%).
The
mean interval between intubation, admission to ICU,
hospital admission and the identification
of VAP was 3.3 days, 4.5 days and 5.4 days, respectively.
Development of VAP was associated with an increase of >$40,000
in mean hospital charges per
patient.
| Measure |
Patients with VAP |
Patients without
VAP - Control |
p value |
| Hospital Mortality |
30.5% |
30.4% |
0.713 |
Mechanical
Ventilation |
14.3 ± 15.5 days |
4.7 ± 7.0 days |
<0.001 |
| ICU Stay |
11.7 ± 11.0 days |
5.6 ± 6.1 days |
<0.001 |
| Hospital Stay |
25.5 ± 22.8 days |
14.0 ± 14.6 days |
<0.001 |
Mean Hospital
Charges per Patient |
$104,983 ± $91,080 |
$63,689 ± $75,030 |
<0.001 |
Conclusion "This retrospective matched cohort
study, the largest of its kind, demonstrates that VAP is
a
common nosocomial infection that is associated with poor
clinical outcomes and economic
outcomes.”
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