A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology

Bonell, Ana; Azarrafiy, Ryan; Huong, Vu Thi Lan; Viet, Thanh Le; Phu, Vu Dinh; Dat, Vu Quoc; Wertheim, Heiman; Doorn, H. Rogier van; Lewycka, Sonia; Nadjm, Behzad

doi:10.1093/cid/ciy543

Cited by 98 publications

(95 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A continuous decrease in the VAP incidence rate and a simultaneous continuous increase in the microbiology detection rate before antibiotic use were found in hospitals in high-income provinces but not in hospitals in low-and middle-income provinces. Bonell A [35] and Hurley JC [36] also observed low VAP incidence rates in high-income areas. This may be related to the financial advantages, human resource advantages and policy advantages of highincome areas in the field of health care.…”

Section: Discussionmentioning

confidence: 91%

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Ma²,

et al. 2020

Crit Care

View full text Add to dashboard Cite

Introduction: Patient safety and critical care quality remain a challenging issue in the ICU. However, the effects of the national quality improvement (QI) program remain unknown in China. Methods: A national ICU QI program was implemented in a controlled cohort of 586 hospitals from 2016 to 2018. The effects of the QI program on critical care quality were comprehensively investigated. Main results: A total of 81,461,554 patients were enrolled in 586 hospitals, and 1,587,724 patients were admitted to the ICU over 3 years. In 2018, there was a significantly higher number of ICU beds (2016 vs. 2018: 10668 vs. 13,661, P = 0.0132) but a lower doctor-to-bed ratio (2016 vs. 2018: 0.64 (0.50, 0.83) vs. 0.60 (0.45, 0.75), P = 0.0016) and nurse-to-bed ratio (2016 vs. 2018: 2.00 (1.64, 2.50) vs. 2.00 (1.50, 2.40), P = 0.031) than in 2016. Continuous and significant improvements in the ventilator-associated pneumonia (VAP) incidence rate, microbiology detection rate before antibiotic use and deep vein thrombosis (DVT) prophylaxis rate were associated with the implementation of the QI program (VAP incidence rate (per 1000 ventilator-days), 2016 vs. 0.0093). Moreover, the 6-h SSC bundle compliance rates in 2018 were significantly higher than those in 2016 (6-h SSC bundle compliance rate, 2016 vs. 2018: 64.93 (33.55, 93.06) vs. 76.19 (46.88, 96.67)). A significant change trend was not found in the ICU mortality rate from 2016 to 2018 (ICU mortality rate (%), 2016 vs. 2017 vs. 2018: 8.49 (4.42, 14.82) vs. 8.95 (4.89, 15.70) vs. 9.05 (5.12, 15.80), P = 0.1075). Conclusions: The relationship between medical human resources and ICU overexpansion was mismatched during the past 3 years. The implementation of a national QI program improved ICU performance but did not reduce ICU mortality.

show abstract

Section: Discussionmentioning

confidence: 91%

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Ma²,

et al. 2020

Crit Care

View full text Add to dashboard Cite

show abstract

“…Although a systematic analysis of the requirement of all TCS genes in biofilm formation has not been attempted in a single study, several studies have looked at the role of many TCS components in biofilm formation. The majority of these studies were done in microtitre plates (polystyrene material), and some on PVC surface or glass surface [11,16,25,40,73,[92][93][94][95][96][97][98][99][100]. These studies have reported many TCS mutants with increased biofilm biomass.…”

Section: Discussionmentioning

confidence: 99%

“…The ETT is the site of biofilm formation by bacteria that can dislodge into the lungs to infect the tissue [3][4][5][6][7][8][9]. Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus are the most common bacterial species in the biofilm found in infected patients [10,11]. P. aeruginosa alone is responsible for 35.8 % mortality seen in VAP patients [12].…”

Section: Introductionmentioning

confidence: 99%

Pseudomonas aeruginosa biofilm formation on endotracheal tubes requires multiple two-component systems

Badal

Jayarani

Kollaran

et al. 2020

Journal of Medical Microbiology

View full text Add to dashboard Cite

Introduction. Indwelling medical devices such as endotracheal tubes (ETTs), urinary catheters, vascular access devices, tracheostomies and feeding tubes are often associated with hospital-acquired infections. Bacterial biofilm formed on the ETTs in intubated patients is a significant risk factor associated with ventilator-associated pneumonia. Pseudomonas aeruginosa is one of the four frequently encountered bacteria responsible for causing pneumonia, and the biofilm formation on ETTs. However, understanding of biofilm formation on ETT and interventions to prevent biofilm remains lagging. The ability to sense and adapt to external cues contributes to their success. Thus, the biofilm formation is likely to be influenced by the two-component systems (TCSs) that are composed of a membrane-associated sensor kinase and an intracellular response regulator. Aim. This study aims to establish an in vitro method to analyse the P. aeruginosa biofilm formation on ETTs, and identify the TCSs that contribute to this process. Methodology. In total, 112 P. aeruginosa PA14 TCS mutants were tested for their ability to form biofilm on ETTs, their effect on quorum sensing (QS) and motility. Results. Out of 112 TCS mutants studied, 56 had altered biofilm biomass on ETTs. Although the biofilm formation on ETTs is QS-dependent, none of the 56 loci controlled quorum signal. Of these, 18 novel TCSs specific to ETT biofilm were identified, namely, AauS, AgtS, ColR, CopS, CprR, NasT, KdpD, ParS, PmrB, PprA, PvrS, RcsC, PA14_11120, PA14_32580, PA14_45880, PA14_49420, PA14_52240, PA14_70790. The set of 56 included the GacS network, TCS proteins involved in fimbriae synthesis, TCS proteins involved in antimicrobial peptide resistance, and surface-sensing. Additionally, several of the TCS-encoding genes involved in biofilm formation on ETTs were found to be linked to flagellum-dependent swimming motility. Conclusions. Our study established an in vitro method for studying P. aeruginosa biofilm formation on the ETT surfaces. We also identified novel ETT-specific TCSs that could serve as targets to prevent biofilm formation on indwelling devices frequently used in clinical settings.

show abstract

“…The EU-VAP/CAP study, for example, reported an incidence density of 18.3 VAP episodes per 1000 ventilator-days [6]. Lower-middle-income countries also report higher rates compared to US hospitals and highincome countries in particular (18.5 vs 9.0 per 1000 ventilator-days; P = .035) [7]. These large discrepancies are at least in part explained by differences in definitions, differences in how definitions are applied, diagnostic limitations of all definitions, and differences in microbiological sampling methods [8].…”

Section: Epidemiologymentioning

confidence: 99%

Ventilator-associated pneumonia in adults: a narrative review

Papazian¹,

2020

View full text Add to dashboard Cite

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections. Reported incidences vary widely from 5 to 40% depending on the setting and diagnostic criteria. VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated attributable mortality of VAP is around 10%, with higher mortality rates in surgical ICU patients and in patients with mid-range severity scores at admission. Microbiological confirmation of infection is strongly encouraged. Which sampling method to use is still a matter of controversy. Emerging microbiological tools will likely modify our routine approach to diagnosing and treating VAP in the next future. Prevention of VAP is based on minimizing the exposure to mechanical ventilation and encouraging early liberation. Bundles that combine multiple prevention strategies may improve outcomes, but large randomized trials are needed to confirm this. Treatment should be limited to 7 days in the vast majority of the cases. Patients should be reassessed daily to confirm ongoing suspicion of disease, antibiotics should be narrowed as soon as antibiotic susceptibility results are available, and clinicians should consider stopping antibiotics if cultures are negative.

show abstract

A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology

Cited by 98 publications

References 36 publications

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Effects of a national quality improvement program on ICUs in China: a controlled pre-post cohort study in 586 hospitals

Pseudomonas aeruginosa biofilm formation on endotracheal tubes requires multiple two-component systems

Ventilator-associated pneumonia in adults: a narrative review

Contact Info

Product

Resources

About