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Ventilator associated pneumonia in intensive care unit patients: a systematic review
Hassan Mumtaz1, Muhammad Saqib2, Wajiha Khan3
1Health Services Academy.
Abstract:
Ventilator-associated pneumonia (VAP) is the most common ICU acquired pneumonia among patients who are invasively intubated for mechanical ventilation. Patients with VAP suffer an increased mortality risk, financial burden, and length of stay in the hospital. The authors aimed to review the literature to describe the incidence, mortality, and microbiological evidence of VAP. We selected 13 peer-reviewed articles published from 1 January 2010 to 15 September 2022 from electronic databases for studies among adult or pediatric patients diagnosed with VAP expressed per thousand days admitted in the ICU. The VAP rates ranged from 7 to 43 per thousand days, varying among different countries of the world. A significant rate of mortality was observed in 13 studies ranging from 6.3 to 66.9%. Gram-negative organisms like Acinetobacter spp., Pseudomonas aeruginosa Gram-positive organisms like Staphylococcus aureus were frequently found. Our findings suggest an alarming situation of VAP among patients admitted to the intensive care units with increasing incidence and mortality. The review also found that VAP is more common in males and that there is a significant variation in the incidence and mortality rates of VAP among different countries. The findings of this review can inform the development of infection control and prevention strategies to reduce the burden of VAP. Thus, there is a crucial need for control and preventive measures like interventional studies and educational programs on staff training, hand-hygiene, and the appropriate use of ventilator bundle approach to curb this preventable threat that is increasing at an alarming rate.
Insights
Ventilator-associated pneumonia (VAP) is a significant threat in ICUs, with incidence rates from 7-43 per thousand days and mortality up to 66.9%. Urgent control measures are needed to combat this rising problem.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired pneumonia in mechanically ventilated patients.
- VAP significantly increases patient mortality, hospital costs, and length of stay.
- Understanding VAP's incidence, mortality, and microbiology is crucial for effective management.
Purpose of the Study:
- To conduct a literature review on the incidence, mortality, and microbiological characteristics of VAP.
- To synthesize current data on VAP rates and associated risk factors.
- To highlight the global variation in VAP epidemiology.
Main Methods:
- Systematic review of 13 peer-reviewed articles published between January 2010 and September 2022.
- Inclusion of studies on adult or pediatric patients diagnosed with VAP.
- Data extraction on VAP incidence (per thousand ICU days), mortality rates, and causative microorganisms.
Main Results:
- VAP incidence rates varied globally, ranging from 7 to 43 per thousand ICU days.
- Mortality rates across the included studies spanned from 6.3% to 66.9%.
- Commonly identified pathogens included Gram-negative bacteria (Acinetobacter spp., Pseudomonas aeruginosa) and Gram-positive bacteria (Staphylococcus aureus).
- VAP was found to be more prevalent in males, with significant international variations in incidence and mortality.
Conclusions:
- VAP presents an alarming and increasing challenge in ICUs worldwide.
- Effective infection control and prevention strategies are urgently required.
- Recommendations include interventional studies, staff education, emphasizing hand hygiene, and consistent application of the ventilator bundle approach.
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