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Updated: Sep 20, 2026

Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Ventilator-associated pneumonia: caveats for benchmarking
Philippe Eggimann1, Stéphane Hugonnet, Hugo Sax
1Infection Control Program, Department of Internal Medicine, University Hospitals of Geneva, 1211, Geneva 14, Switzerland.
Objective:
To determine the influence of using different denominators on risk estimates of ventilator-associated pneumonia (VAP).
Design And Setting:
Prospective cohort study in the medical ICU of a large teaching hospital.
Patients:
All consecutive patients admitted for more than 48 h between October 1995 and November 1997.
Measurements And Results:
We recorded all ICU-acquired infections using modified CDC criteria. VAP rates were reported per 1,000 patient-days, patient-days at risk, ventilator-days, and ventilator-days at risk. Of the 1,068 patients admitted, VAP developed in 106 (23.5%) of those mechanically ventilated. The incidence of the first episode of VAP was 22.8 per 1,000 patient-days (95% CI 18.7-27.6), 29.6 per 1,000 patient-days at risk (24.2-35.8), 35.7 per 1,000 ventilator-days (29.2-43.2), and 44.0 per 1,000 ventilator-days at risk (36.0-53.2). When considering all episodes of VAP (n=127), infection rates were 27.3 episodes per 1,000 ICU patient-days (95% CI 22.6-32.1) and 42.8 episodes per 1,000 ventilator-days (35.3-50.2).
Conclusions:
The method of reporting VAP rates has a significant impact on risk estimates. Accordingly, clinicians and hospital management in charge of patient-care policies should be aware of how to read and compare nosocomial infection rates.
Insights
Reporting ventilator-associated pneumonia (VAP) rates using different denominators significantly impacts risk estimates. Understanding these variations is crucial for accurate comparison of hospital-acquired infection rates.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Ventilator-associated pneumonia (VAP) is a significant hospital-acquired infection in intensive care units (ICUs).
- Accurate risk estimation is vital for effective infection control strategies.
- Standardized reporting methods for VAP are essential for reliable comparisons.
Purpose of the Study:
- To evaluate the impact of various denominators on the calculated risk estimates for VAP.
- To compare VAP incidence rates reported per patient-day, patient-day at risk, ventilator-day, and ventilator-day at risk.
Main Methods:
- Prospective cohort study conducted in a medical ICU of a large teaching hospital.
- Inclusion of consecutive patients admitted for over 48 hours between October 1995 and November 1997.
- Recording of ICU-acquired infections using modified CDC criteria and calculation of VAP rates using multiple denominators.
Main Results:
- VAP developed in 106 (23.5%) of 1,068 mechanically ventilated patients.
- Incidence rates varied significantly based on the denominator used, ranging from 22.8 to 44.0 per 1,000 units.
- Reporting VAP per 1,000 ventilator-days at risk yielded the highest incidence rate.
Conclusions:
- The choice of denominator substantially influences VAP risk estimates.
- Clinicians and hospital administrators must be aware of these reporting differences to interpret and compare infection rates accurately.
- Standardized reporting practices are recommended to ensure consistency in VAP surveillance.
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