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* From the University Hospital Joan XXIII (Dr. Rello), University Rovira and Virgili, Tarragona, Spain; Policy Analysis Inc. (Drs. Oster and Vera-Llonch and Mr. Ollendorf), Boston, MA; IntraBiotics Pharmaceuticals, Inc. (Ms. Bellm and Dr. Redman), Mountain View, CA; and Washington University School of Medicine (Dr. Kollef), St. Louis, MO.
A list of VAP Outcomes Scientific Advisory Group members is located in the Appendix.
Correspondence to: Marin H. Kollef, MD, FCCP, Washington University School of Medicine, Campus Box 8052, 660 South Euclid Ave, St. Louis, MO 63110; e-mail: kollefm{at}msnotes.wustl.edu
Objectives: To evaluate risk factors for ventilator-associated pneumonia (VAP), as well as its influence on in-hospital mortality, resource utilization, and hospital charges.
Design: Retrospective matched cohort study using data from a large US inpatient database.
Patients: Patients admitted to an ICU between January 1998 and June 1999 who received mechanical ventilation for > 24 h.
Measurements: Risk factors for VAP were examined using crude and adjusted odds ratios (AORs). Cases of VAP were matched on duration of mechanical ventilation, severity of illness on admission (predicted mortality), type of admission (medical, surgical, trauma), and age with up to three control subjects. Mortality, resource utilization, and billed hospital charges were then compared between cases and control subjects.
Results: Of the 9,080 patients meeting study entry criteria, VAP developed in 842 patients (9.3%). The mean interval between intubation, admission to the ICU, hospital admission, and the identification of VAP was 3.3 days, 4.5 days, and 5.4 days, respectively. Identified independent risk factors for the development of VAP were male gender, trauma admission, and intermediate deciles of underlying illness severity (on admission) [AOR, 1.58, 1.75, and 1.47 to 1.70, respectively]. Patients with VAP were matched with 2,243 control subjects without VAP. Hospital mortality did not differ significantly between cases and matched control subjects (30.5% vs 30.4%, p = 0.713). Nevertheless, patients with VAP had a significantly longer duration of mechanical ventilation (14.3 ± 15.5 days vs 4.7 ± 7.0 days, p < 0.001), ICU stay (11.7 ± 11.0 days vs 5.6 ± 6.1 days, p < 0.001), and hospital stay (25.5 ± 22.8 days vs 14.0 ± 14.6 days, p < 0.001). Development of VAP was also associated with an increase of > $40,000 in mean hospital charges per patient ($104,983 ± $91,080 vs $63,689 ± $75,030, p < 0.001).
Conclusions: This retrospective matched cohort study, the largest of its kind, demonstrates that VAP is a common nosocomial infection that is associated with poor clinical and economic outcomes. While strategies to prevent the occurrence of VAP may not reduce mortality, they may yield other important benefits to patients, their families, and hospital systems.
Key Words: critical care • hospital costs • ICU • mechanical ventilation • outcome • ventilator-associated pneumonia
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