Effect of ICU quality control indicators on VAP incidence and mortality: a Retrospective Study of 1267 hospitals in China

Abstract

Purpose To investigate the effects of ICU quality control indicators on the VAP morbidity and mortality in China throughout 2019 Methods This was a retrospective study. A total of 1267 ICUs from 30 provinces in mainland China were included. Data were collected using the National Clinical Improvement System Data that reports ICU information. 10 related quality control indicators were analyzed, including 5 structural factors (patient-to-bed ratio, physician-to-bed ratio, nurse-to-bed ratio, patient-to-physician ratio, patient-to-nurse ratio), 3 process factors (unplanned endotracheal extubation rate, reintubation rate within 48h, and microbiology detection rate before antibiotic use) and 2 outcome factors (VAP morbidity and mortality). The information of most common infectious pathogens and most common used antibiotics in ICU was also collected. Generalized linear mixed models were used to analyze the association between these factors and VAP morbidity and mortality. Results The morbidity of VAP in these hospitals in 2019 was 5.03 (2.38, 10.25) per 1000 ventilator days, and the mortality of VAP was 11.11 (0.32, 26.00)%. The most common causative pathogen was Acinetobacter baumannii (in 39.98% hospitals), followed by Klebsiella pneumoniae (38.26%), Pseudomonas aeruginosa and Escherichia coli. In 26.90% hospitals, third-generation cephalosporin was the most used antibiotics, followed by carbapenem (24.22%), penicillin and beta-lactamase inhibitor combination (20.09%), cephalosporin with beta-lactamase inhibitor (17.93%). All the structural factors were significantly associated with VAP morbidity, but not with the mortality, although the trend was inconsistent. Process factors including unplanned endotracheal extubation rate, reintubation rate in 48 hours and microbiology detection rate before antibiotic use were associated with higher VAP mortality, while unplanned endotracheal extubation rate and reintubation rate in 48 hours were associated with higher VAP mortality. Furthermore, K. pneumoniae as the most common pathogen was associated with higher VAP mortality, and carbapenems as the most used antibiotics was associated with lower VAP mortality. Conclusion This study highlights the association between the ICU QC factors and VAP morbidity and mortality. The process factors rather than the structural factors need to be further improved for the QC of VAP in ICU.