Search

Abstract Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Design: Prospective cohort study. Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. Participants: The study included patients admitted to ICUs across 24 years. Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16–1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P < .0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23–1.31; P < .0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57–15.48; P < .0001); tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31; 95% CI, 7.21–9.58; P < .0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34–7.21; P < .0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17–1.29; P < .0001); admission to a public hospital (aOR, 1.59; 95% CI, 1.35-1.86; P < .0001); middle-income country (aOR, 1.22; 95% CI, 15–1.29; P < .0001); admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05; 95% CI, 3.22–5.09; P < .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48; 95% CI, 1.78–3.45; P < .0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79–3.07; P < .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51–0.77; P < .0001). Conclusions: Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.

Federico A Zumaya-Estrada,1 Alfredo Ponce-de-León-Garduño,2 Edgar Ortiz-Brizuela,2 Juan Carlos Tinoco-Favila,3 Patricia Cornejo-Juárez,4 Diana Vilar-Compte,4 Alejandro Sassoé-González,5 Pedro Jesus Saturno-Hernandez,6 Celia M Alpuche-Aranda1 1Center for Infectious Diseases Research (CISEI), National Institute of Public Health (INSP), Cuernavaca, C.P. 62100, Morelos, México; 2Infectology Department, National Institute of Medical Sciences and Nutrition “Salvador Zubirán”, Ciudad de México, C.P. 14080, México; 3Infectology Department, Hospital General 450, Secretary of Health of Durango, Durango, C.P. 34206, Durango, México; 4Infectious Diseases Department, National Institute of Cancer (INCan), Ciudad de México, C.P. 14080, México; 5Epidemiological Intelligence Unit, High Specialty Regional Hospital of Ixtapaluca, Estado de México, C.P. 56530, México; 6Center for Evaluation and Surveys Research (CIEE), National Institute of Public Health (INSP), Cuernavaca, C.P. 62100, Morelos, MéxicoCorrespondence: Celia M Alpuche-ArandaCenter for Infectious Diseases Research (CISEI), National Institute of Public Health (INSP), Cuernavaca, C.P. 62100, Morelos, MéxicoTel +52 777-329-3000 ext. 2101Email celia.alpuche@insp.mxPedro Jesus Saturno-HernandezCenter for Evaluation and Surveys Research (CIEE), National Institute of Public Health (INSP), Cuernavaca, C.P. 62100, Morelos, MéxicoTel +52 777-329-3000 ext. 4332Email pedro.saturno@insp.mxPurpose: To describe the antimicrobial use in four tertiary care hospitals in Mexico.Patients and Methods: Point prevalence surveys (PPSs) were conducted on medical records of hospitalized patients with prescribed antimicrobials (AMs) in four tertiary care hospitals in Mexico in 2019. Prevalence estimates and descriptive statistics were used to present the collected data on antimicrobial prescribing and microbiological studies.Results: The prevalence of patients with prescribed AMs among the hospitals ranged from 47.1% to 91.3%. Antibiotics for systemic use (J01s) were the most prescribed (84.6%, [95% CI: 81.5– 87.3]), mainly extended-spectrum J01s: third-generation cephalosporins 19.8% [95% CI: 16.8– 23.1], and carbapenems 17.0% [95% CI: 14.2– 20.2]. Antibiotic treatments were largely empirical, with no planned duration or review dates. The ceftriaxone use was excessive and prolonged. No formal reference guidelines for antimicrobial prescribing were available in the hospitals. Multidrug-resistant Escherichia coli and ESKAPE pathogens were identified in all hospitals.Conclusion: This study describes the extensive use of antimicrobials and broad-spectrum antibiotics for systemic use in Mexican hospitals, along with the presence of resistant pathogens to the antibiotics frequently used in the hospitals surveyed.Keywords: PPSs, antimicrobial use, antibiotics, Mexican hospitals