Updated risk factors for ventilator-associated pneumonia: findings from a matched case-control VAPRISK study.

BACKGROUND

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 ventilator-associated pneumonia (VAP) within a low-resource clinical setting to provide evidence-based targets for prevention in such environments.

METHODS

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

RESULTS

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.

CONCLUSIONS

In a patient cohort matched for age, sex, and duration of MV, multi-variate 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.