The Epidemiological Characteristics of Ventilator-associated Pneumonia in Neurosurgery: A Ten-year Surveillance Study in A Large Chinese Tertiary Hospital

Abstract

Background: Ventilator-associated pneumonia (VAP) is a significant and common health concern, and epidemiological landscape of VAP is poorly understood in neurosurgery. The current study aimed to explore the epidemiology of VAP in neurosurgery with the goal of devising better-targeted surveillance, treatment and control efforts. Methods: A ten-year retrospective study was performed in a large Chinese tertiary hospital, and we collected surveillance data on neurosurgical patients with VAP and used descriptive analysis to map the demographic and clinical characteristics of VAP as well as the distribution and antimicrobial resistance profile of leading pathogens. Risk factors associated with the presence of VAP were explored using boosted regression tree (BRT) models. Results: During 2011-2020, a total of 310 VAP patients were identified. The ten-year incidence of VAP was 16.21 per 1000 ventilation days with all-cause mortality rate of 6.1%. The proportions of gram-negative bacteria, fungi and gram-positive bacteria in 357 isolates from 310 VAP patients were 86.0%, 7.6% and 6.4%, and most of them were multidrug-resistant organisms. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common pathogens causing VAP, and high detection rates of CRAB, CRPA and CRKP with an upward trend were observed. The BRT modes revealed that there were various associations of VAP presence with the days of ventilator use (relative contribution: 47.84 ± 7.25), GCS score (relative contribution: 24.72 ± 5.67), and tracheotomy (relative contribution: 21.50 ± 2.69), respectively. Conclusions: Our findings provide a better understanding of epidemiological characteristics and risk factors for VAP in neurosurgery.