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Title: Incidence and predictors of ventilator-associated pneumonia using a competing risk analysis: a single-center prospective cohort study in Egypt.
Authors: Elsheikh, Mohamed
Kuriyama, Akira
Goto, Yoshihito
Takahashi, Yoshimitsu  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0003-4073-9945 (unconfirmed)
Toyama, Mayumi
Nishikawa, Yoshitaka  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0003-3313-1990 (unconfirmed)
El Heniedy, Mohamed Ahmed
Abdelraouf, Yasser Mohamed
Okada, Hiroshi
Nakayama, Takeo  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-7918-6252 (unconfirmed)
Author's alias: 栗山, 明
後藤, 禎人
高橋, 由光
當山, まゆみ
西川, 佳孝
岡田, 浩
中山, 健夫
Keywords: Developing countries
Incidence
Pneumonia, ventilator-associated
Respiration, artificial
Risk factors
Fine-Gray competing risk regression model
Subdistribution hazard ratio.
Issue Date: 19-Sep-2024
Publisher: Springer Nature
BMC
Journal title: BMC Infectious Diseases
Volume: 24
Thesis number: 1007
Abstract: Background: Ventilator-associated pneumonia (VAP) is a challenging nosocomial problem in low- and middle-income countries (LMICs) that face barriers to healthcare delivery and resource availability. This study aimed to examine the incidence and predictors of VAP in Egypt as an example of an LMIC while considering death as a competing event. Methods: The study included patients aged ≥ 18 years who underwent mechanical ventilation (MV) in an intensive care unit (ICU) at a tertiary care, university hospital in Egypt between May 2020 and January 2023. We excluded patients who died or were transferred from the ICU within 48 h of admission. We determined the VAP incidence based on clinical suspicion, radiological findings, and positive lower respiratory tract microbiological cultures. The multivariate Fine-Gray subdistribution hazard model was used to examine the predictors of VAP while considering death as a competing event. Results: Overall, 315 patients were included in this analysis. Sixty-two patients (19.7%) developed VAP (17.1 per 1000 ventilator days). The Fine-Gray subdistribution hazard model, after adjustment for potential confounders, revealed that emergency surgery (subdistribution hazard ratio [SHR]: 2.11, 95% confidence interval [CI]: 1.25-3.56), reintubation (SHR: 3.74, 95% CI: 2.23-6.28), blood transfusion (SHR: 2.23, 95% CI: 1.32-3.75), and increased duration of MV (SHR: 1.04, 95% CI: 1.03-1.06) were independent risk factors for VAP development. However, the new use of corticosteroids was not associated with VAP development (SHR: 0.94, 95% CI: 0.56-1.57). Klebsiella pneumoniae was the most common causative microorganism, followed by Pseudomonas aeruginosa. Conclusion: The incidence of VAP in Egypt was high, even in the ICU at a university hospital. Emergency surgery, reintubation, blood transfusion, and increased duration of MV were independently associated with VAP. Robust antimicrobial stewardship and infection control strategies are urgently needed in Egypt.
Rights: © The Author(s) 2024.
This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
URI: http://hdl.handle.net/2433/290110
DOI(Published Version): 10.1186/s12879-024-09909-6
PubMed ID: 39300386
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