Updated Risk Factors for Ventilator-Associated Pneumonia: Findings from a Matched Case-Control VAPRISK Study

Although prevention bundles and surveillance systems are widely used, the incidence of ventilator-associated events rose by 13% in 2023. This study aimed to identify independent risk factors for VAP within a low-resource clinical setting to provide evidence-based targets for prevention in such environments.

Ninety VAP patients were matched 1:1 with controls based on sex, age, and duration of mechanical ventilation at the time of VAP onset. Multivariate logistic regression was used to identify independent risk factors.

After confounding factors were considered, recent cerebrovascular stroke (adjusted odds ratio (OR) = 6.555, 95% confidence interval (CI): 1.768-24.306, p = 0.005), sedation with midazolam (adjusted OR = 3.292, 95% CI: 1.342-8.079, p = 0.009), and prior use of corticosteroids (adjusted OR = 3.369, 95% CI: 1.335-8.505, p = 0.010) were significant risk factors. Regarding the items of the VAP bundle, both "No sedation holiday" (adjusted OR = 6.774, 95% CI: 2.751-16.682, p < 0.001) and "Oral care with chlorhexidine" (adjusted OR = 8.544, 95% CI: 3.334-21.891, p < 0.001) were independently associated with higher odds of VAP.

In a patient cohort matched for age, sex, and duration of MV, multivariate analysis revealed that recent cerebrovascular stroke, midazolam sedation, a lack of sedation holidays, prior corticosteroid use, and chlorhexidine oral care were independently associated with VAP.