Incidence, risk factors, and outcome of ventilator-associated pneumonia.

OBJECTIVE The purpose of this study is to determine the incidence, risk factors, and outcome of ventilator-associated pneumonia (VAP). DESIGN Prospective cohort. SETTING Three hundred sixty-one intensive care units (ICUs) from 20 countries. PATIENTS AND PARTICIPANTS Two thousand eight hundred ninety-seven patients mechanically ventilated for more than 12 hours. MEASUREMENTS AND RESULTS Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple organ failure over the course of mechanical ventilation, and outcome were collected. Ventilator-associated pneumonia was present in 439 patients (15%). Patients with VAP were more likely to have chronic pulmonary obstructive disease, aspiration, sepsis, and acute respiratory distress syndrome. Mortality in patients with VAP was 38%. Factors associated with mortality were severity of illness, limited activity before the onset of mechanical ventilation and development of shock, acute renal failure, and worsening of hypoxemia during the period of mechanical ventilation. Case-control analysis showed no increased mortality in patients with VAP (38.1% vs 37.9%, P = .95) but prolonged duration of mechanical ventilation and ICU stay. CONCLUSION In a large cohort of mechanically ventilated patients, VAP is more likely in patients with underlying lung disease (acute or chronic). Ventilator-associated pneumonia was associated with a significant increase in ICU length of stay but no increase in mortality.