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Updated: Mar 13, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
World-wide variation in incidence of Acinetobacter associated ventilator associated pneumonia: a meta-regression
James C Hurley1,2,3
1Department of Rural Health, Melbourne Medical School, University of Melbourne, Ballarat, 3353, Australia. jamesh@bhs.org.au.
Background:
Acinetobacter species such as Acinetobacter baumanii are of increasing concern in association with ventilator associated pneumonia (VAP). In the ICU, Acinetobacter infections are known to be subject to seasonal variation but the extent of geographic variation is unclear. The objective here is to define the extent and possible reasons for geographic variation for Acinetobacter associated VAP whether or not these isolates are reported as Acinetobacter baumanii.
Methods:
A meta-regression model of VAP associated Acinetobacter incidence within the published literature was undertaken using random effects methods. This model incorporated group level factors such as proportion of trauma admissions, year of publication and reporting practices for Acinetobacter infection.
Results:
The search identified 117 studies from seven worldwide regions over 29 years. There is significant variation in Acinetobacter species associated VAP incidence among seven world-wide regions. The highest incidence is amongst reports from the Middle East (mean; 95 % confidence interval; 8.8; 6 · 2-12 · 7 per 1000 mechanical ventilation days) versus that from North American ICU's (1 · 2; 0 · 8-2 · 1). There is a similar geographic related disparity in incidence among studies reporting specifically as Acinetobacter baumanii. The incidence in ICU's with a majority of admission being for trauma is >2.5 times that of other ICU's.
Conclusion:
There is greater than fivefold variation in Acinetobacter associated VAP among reports from various geographic regions worldwide. This variation is not explainable by variations in rates of VAP overall, admissions for trauma, publication year or Acinetobacter reporting practices as group level variables.
Insights
Geographic location significantly impacts Acinetobacter-associated ventilator-associated pneumonia (VAP) incidence, with the Middle East showing higher rates than North America. This variation is not explained by trauma admissions or reporting practices.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Acinetobacter species, particularly Acinetobacter baumannii, are a growing concern for ventilator-associated pneumonia (VAP).
- While seasonal variations in Acinetobacter infections are known in ICUs, the extent of geographic variation remains unclear.
- Understanding geographic disparities is crucial for targeted VAP prevention and management strategies.
Purpose of the Study:
- To determine the extent of geographic variation in Acinetobacter-associated VAP incidence globally.
- To explore potential reasons for observed geographic disparities in Acinetobacter VAP rates.
Main Methods:
- A meta-regression analysis was conducted on published literature concerning VAP associated with Acinetobacter.
- The model utilized random effects methods to analyze incidence data.
- Group-level factors, including trauma admission rates, publication year, and Acinetobacter reporting practices, were incorporated.
Main Results:
- The analysis included 117 studies across seven global regions spanning 29 years.
- Significant geographic variation in Acinetobacter-associated VAP incidence was observed, with the Middle East reporting higher rates (8.8 per 1000 ventilation days) compared to North America (1.2 per 1000 ventilation days).
- Higher incidence rates were also noted in ICUs with a majority of trauma admissions (>2.5 times other ICUs).
Conclusions:
- A greater than fivefold variation in Acinetobacter-associated VAP incidence exists across different geographic regions worldwide.
- This significant variation cannot be attributed to overall VAP rates, trauma admission proportions, publication year, or Acinetobacter reporting practices.
- Further research is needed to elucidate the underlying drivers of these geographic disparities in Acinetobacter VAP.
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