Multinational prospective cohort study over 18 years of the risk factors for ventilator-associated pneumonia in 9 Asian countries: INICC findings

Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p.0001); public (OR=1.84; 95%CI=1.49-2.26, P.0001), and private (OR=1.57; 95%CI=1.29-1.91, P.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P.0001) showed the highest risk.Some identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.