Colaneri Marta, Montrucchio Giorgia, Scaglione Giovanni, Monti Gianpaola, Tricella Giovanni, Genovese Camilla, Agostini Fulvio, Dore Francesca, Viaggi Bruno, Brazzi Luca, Sanna Valentina, Gori Andrea, Palomba Emanuele, Offer Martina, Finazzi Stefano
Department of Infectious Diseases, Luigi Sacco Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy.
Department of Surgical Sciences, University of Turin, Turin, Italy; Department of Anesthesia, Intensive Care and Emergency 'Città della Salute e della Scienza' Hospital, Turin, Italy.
Clin Microbiol Infect. 2025 May 27. doi: 10.1016/j.cmi.2025.05.026.
Despite preventive measures, ventilator-associated pneumonia (VAP) remains the most common healthcare-associated infection in the intensive care unit (ICU). VAP's striking incidence and impact are a leading cause of morbidity and prolonged ICU stay. This study focused on the characteristics and outcomes of patients diagnosed with ICU-acquired VAPs in Italian ICUs.
Data were drawn from the PROSAFE network, a prospective multicentric observational project conducted across 192 Italian ICUs (2014-2023). Clinical data were recorded following the European Centre for Disease Prevention and Control VAP definitions. The incidence rate was estimated, and multivariable logistic regression identified ICU mortality risk factors.
The patients admitted to the included ICUs were 402 085. Among 122 430 classified at risk for VAP because of invasive mechanical ventilation (IMV) ≥48 hours, a total of 11 978 VAP cases were identified, corresponding to a prevalence of 9.8%. The incidence rate of VAP was 10.47 cases per 1 000 ventilator days (95% CI: 10.28-10.66). Patients with VAP exhibited prolonged ICU stays (median: 23 days, Q1-Q3: 15-36) and high mortality (30.0%). Microbiological profiling of VAP identified Pseudomonas spp. (21.0%), Staphylococcus aureus (20.2%), and Klebsiella spp. (20.1%) as the predominant pathogens. The logistic regression showed that older age, chronic liver and kidney diseases, multidrug-resistant organisms, and Acinetobacter spp. aetiology and duration of ICU stay before VAP were significantly associated with higher mortality.
While confirming the overall high mortality of patients undergoing IMV, our findings highlight the significantly prolonged ICU stay in VAP patients, and the influence of multidrug-resistant organisms on VAP-related mortality. These insights emphasize the necessity for effective and timely preventive strategies, as well as the early identification of VAP aetiology.
尽管采取了预防措施，但呼吸机相关性肺炎（VAP）仍是重症监护病房（ICU）中最常见的医疗相关感染。VAP惊人的发病率和影响是导致发病和ICU住院时间延长的主要原因。本研究聚焦于意大利ICU中诊断为ICU获得性VAP的患者的特征和结局。
数据来自PROSAFE网络，这是一项在192个意大利ICU（2014 - 2023年）开展的前瞻性多中心观察项目。临床数据根据欧洲疾病预防控制中心的VAP定义进行记录。估计发病率，并通过多变量逻辑回归确定ICU死亡风险因素。
纳入ICU的患者有402085例。在因有创机械通气（IMV）≥48小时而被归类为有VAP风险的122430例患者中，共识别出11978例VAP病例，患病率为9.8%。VAP的发病率为每1000个呼吸机日10.47例（95%置信区间：10.28 - 10.66）。VAP患者的ICU住院时间延长（中位数：23天，第一四分位数 - 第三四分位数：15 - 36天）且死亡率高（30.0%）。VAP的微生物谱分析确定铜绿假单胞菌属（21.0%）、金黄色葡萄球菌（20.2%）和克雷伯菌属（20.1%）为主要病原体。逻辑回归显示，年龄较大、慢性肝肾疾病、多重耐药菌以及不动杆菌属病因和VAP发生前的ICU住院时间与较高死亡率显著相关。
虽然证实了接受IMV患者的总体高死亡率，但我们的研究结果突出了VAP患者ICU住院时间显著延长，以及多重耐药菌对VAP相关死亡率的影响。这些见解强调了有效及时的预防策略以及早期识别VAP病因的必要性。
