The epidemiology of ventilator-associated pneumonia in a network of community hospitals: a prospective multicenter study

Abstract

Objective: To describe the epidemiology of ventilator-associated pneumonia (VAP) in community hospitals.

Design and setting: Prospective study in 31 community hospitals from 2007 to 2011.

Methods: VAP surveillance was performed by infection preventionists using the National Healthcare Safety Network protocol. VAP incidence was reported as number of events per 1,000 ventilator-days. We categorized hospitals into small (<30,000 patient-days/year), medium (30,000-60,000 patient-days/year), and large (>60,000 patient-days/year) groups and compared VAP incidence by hospital size.

Results: he median VAP incidence was 1.4 (interquartile range, 0.4-2.4), and ventilator utilization ratio (VUR) was 0.33 (0.25-0.47). VAP incidence was higher in small hospitals (2.1) than medium (0.85) or large (0.69) hospitals ([Formula: see text]) despite a lower VUR in small hospitals (0.29 vs 0.31 vs 0.44, respectively; [Formula: see text]). The median age of 247 VAP cases was 64 (53-73); 136 (55.1%) were female; 142 (57.5%) were Caucasian; 170 (68.8%) were admitted from home. The length of stay and duration of ventilation were 26 (14-42) and 12 (4-21) days, respectively. The pre- and postinfection hospital stays were 8 (3-13) days and 14 (8-30) days, respectively. Data on outcomes were available in 214 cases (86.6%), and 75 (35.0%) cases died during hospitalization. The top 3 pathogens were methicillin-resistant Staphylococcus aureus (MRSA; [Formula: see text], 27.9%), Pseudomonas species ([Formula: see text], 16.3%), and Klebsiella species ([Formula: see text], 13.3%).

Conclusions: VAP incidence was inversely associated with size of hospital. VAP in community hospitals was frequently caused by MRSA. Importantly, predictors of VAP incidence in tertiary care hospitals such as VUR may not be predictive in community hospitals with few ventilated patients.

FIGURE 1

Comparison of median ventilator-associated pneumonia incidence (VAP/1,000 ventilator-days) and ventilator utilization ratio (VUR) by hospital size (small group, <30,000 patient-days/year; medium group, 30,000–60,000 patient-days/year; large group, >60,000 patient-days/year).