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Open Access Highly Accessed Research article

Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study

Philippe Vanhems12*, Thomas Bénet12, Nicolas Voirin12, Jean-Marie Januel3, Alain Lepape4, Bernard Allaouchiche5, Laurent Argaud6, Dominique Chassard7, Claude Guérin8 and the Study Group

Author Affiliations

1 Hospices Civils de Lyon, Infection Control Unit, Edouard Herriot Hospital, Lyon, France

2 Laboratory of Epidemiology and Public Health, CNRS UMR 5558, University of Lyon, University of Lyon 1, Lyon, France

3 Health Care Evaluation Unit, Institute of Social and Preventive Medicine-IUMSP, University of Lausanne, Lausanne, Switzerland

4 Hospices Civils de Lyon, Intensive Care Unit, Lyon-South Hospital, Pierre-Bénite, France

5 Hospices Civils de Lyon, Surgical Intensive Care Unit, Edouard Herriot Hospital, Lyon, France

6 Hospices Civils de Lyon, Medical Intensive Care Unit, Edouard Herriot Hospital, Lyon, France

7 Hospices Civils de Lyon, Intensive Care Unit, Mother-Infant Hospital, Bron, France

8 Hospices Civils de Lyon, Medical Intensive Care Unit, Croix-Rousse Hospital, Lyon, France

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BMC Infectious Diseases 2011, 11:236  doi:10.1186/1471-2334-11-236

Published: 6 September 2011

Abstract

Background

The incidence of ventilator-associated pneumonia (VAP) within the first 48 hours of intensive care unit (ICU) stay has been poorly investigated. The objective was to estimate early-onset VAP occurrence in ICUs within 48 hours after admission.

Methods

We analyzed data from prospective surveillance between 01/01/2001 and 31/12/2009 in 11 ICUs of Lyon hospitals (France). The inclusion criteria were: first ICU admission, not hospitalized before admission, invasive mechanical ventilation during first ICU day, free of antibiotics at admission, and ICU stay ≥ 48 hours. VAP was defined according to a national protocol. Its incidence was the number of events per 1,000 invasive mechanical ventilation-days. The Poisson regression model was fitted from day 2 (D2) to D8 to incident VAP to estimate the expected VAP incidence from D0 to D1 of ICU stay.

Results

Totally, 367 (10.8%) of 3,387 patients in 45,760 patient-days developed VAP within the first 9 days. The predicted cumulative VAP incidence at D0 and D1 was 5.3 (2.6-9.8) and 8.3 (6.1-11.1), respectively. The predicted cumulative VAP incidence was 23.0 (20.8-25.3) at D8. The proportion of missed VAP within 48 hours from admission was 11% (9%-17%).

Conclusions

Our study indicates underestimation of early-onset VAP incidence in ICUs, if only VAP occurring ≥ 48 hours are considered to be hospital-acquired. Clinicians should be encouraged to develop a strategy for early detection after ICU admission.