Abstract
BackgroundData to date is far from sufficient to describe the recent epidemiology of ventilator-associated pneumonia (VAP) in mainland China. This study aimed to estimate the overall incidence of VAP, with a special focus on its temporal trend and associated factors.MethodsMeta-analyses of 195 studies published from 2010 to 2015 were conducted, followed by subgroup analyses by methodological quality, pre-defined setting characteristics and attributes of populations.ResultsThe overall cumulative VAP incidence in mainland China was 23.8% (95% confidence interval (CI) 20.6–27.2%), with the results showing high heterogeneity. The pooled incidence densities were 24.14 (95% CI 21.19–27.51) episodes and 22.83 (95% CI 19.88–26.23) patients per 1000 ventilator-days. A decline in the cumulative incidence was observed from 2006 (49.5%, 95% CI 40.0–59.0%) to 2014 (19.6%, 95% CI 10.4–31.0%); differences in the incidence rates were also documented according to Chinese provinces and diagnostic criteria (p < 0.001). Older age (≥60 years), coma, re-intubation, tracheotomy and prolonged ventilation were the factors significantly associated with the occurrence of VAP.ConclusionsThe incidence of VAP remains high in mainland China but has decreased since 2006. The reported rates vary considerably across individual studies, probably due to variations in diagnosis and geographical region. More studies using standard definitions and cut-off points are needed to better clarify the epidemiology of VAP across the country.
Highlights
Data to date is far from sufficient to describe the recent epidemiology of ventilator-associated pneumonia (VAP) in mainland China
Information on the temporal change of the VAP incidence and stratified estimates according to the characteristics of different settings to date are far from sufficient to describe the epidemiology of VAP across the country
General information about the included studies We identified a total of 8282 records and included 195 studies (Fig. 1), of which 93 reported the cumulative incidence of VAP, 50 had an incidence density of VAP episodes per 1000 ventilator-days and 103 reported an estimate of VAP patients per 1000 ventilator-days
Summary
Data to date is far from sufficient to describe the recent epidemiology of ventilator-associated pneumonia (VAP) in mainland China. This study aimed to estimate the overall incidence of VAP, with a special focus on its temporal trend and associated factors. The systematic review, which included 178 studies published between 2007 and 2012, yielded a pooled VAP cumulative incidence of 33.7% in ICUs [6]. Data regarding the nationwide incidence of VAP outside of ICUs remain unavailable. Information on the temporal change of the VAP incidence and stratified estimates according to the characteristics of different settings (such as by Chinese province and diagnostic criteria) to date are far from sufficient to describe the epidemiology of VAP across the country
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