Abstract
SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Ventilator-associated pneumonia (VAP) is a hospital acquired pneumonia that occurs more than 48 hours after mechanical ventilation. Previous epidemiological studies reported temporal trends, predictors, and outcomes of VAP based on regional data or in specific subgroups of patients. In our study we used the National database to delineate the trends and predictors of VAP from 2009 to 2017. METHODS: We analyzed data from the Nationwide Inpatient Sample (NIS) for the years 2009-2017 for adult hospitalizations who received mechanical ventilation by using International Classification of Diseases (9th/10th Editions) Clinical Modification Procedural codes (ICD-9-CM/ICD-10-CM) procedures codes. We excluded hospitalizations with length of stay (LOS <2 days). VAP and other diagnosis of interests were identified by ICD-9-CM diagnosis codes and Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariate survey logistic regression models to analyze temporal incidence trends, predictors. RESULTS: Out of a total 5,155,068 hospitalizations who received mechanical ventilation, 93432(1.81%) developed VAP. Incidence of VAP decreased from 20/1000 in 2008 to 17/1000 in 2017 with 5% decrease (OR 0.95; 95%CI 0.92-0.96; p<0.001). Patients who developed VAP had lower mean age (59 vs 61; p<0.001) and higher LOS (25d Vs. 12d; p<0.001). Furthermore, in multivariable regression analysis, predictors of VAP are males(OR 1.4; 95% CI 1.35-1.45; p<0.0001) and African Americans (OR 1.22; 95% CI 1.14-1.31;p<0.001), paralysis (OR 2.1; 95% CI 2.02-2.21; p<0.001) and congestive heart failure (OR 1.22; CI 1.17-1.27; p<0.0001). Also, age < 65, teaching hospital status and co-morbidities like neurological disorders, pulmonary circulation disorders, anemia and electrolyte disorders are associated with the increased odds of developing VAP. Amongst the patients who developed VAP, 62% were discharged to long term facilities and 19% died during the hospitalization. CONCLUSIONS: In this nationally representative study, we observed incidence of VAP has been decreasing in the last decade. We were also able to delineate several factors that were associated with development of VAP, which are potentially modifiable. CLINICAL IMPLICATIONS: There has been a paucity of nationwide data regarding VAP in the U.S.. Our study identified the trends along with the modifiable or non-modifiable risk predictors of VAP in MV patients. Our goal is to lay foundation for further in-depth analysis of this trend for better risk stratification and development of preventive strategies to further reduce the incidence of VAP among MV patients. DISCLOSURES: No relevant relationships by TANVEER DABRIA, source=Web Response No relevant relationships by Wonkyung Hur, source=Web Response no disclosure on file for Preetam Jolepalem; No relevant relationships by Faizan Malik, source=Web Response No relevant relationships by Uvesh Mansuri, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Hafsa Sabzposh, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by Chail Shah, source=Web Response
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