Prevention Of Ventilator-associated Pneumonia Research Articles

Chlorhexidine is not effective at any concentration in preventing ventilator-associated pneumonia: a systematic review and network meta-analysis

IntroductionOral chlorhexidine has been widely used for ventilator-associated pneumonia prevention in the critical care setting; however, previous studies and evidence synthesis have generated inconsistent findings. Our study aims to investigate if different concentrations of oral chlorhexidine may be effective in preventing such complication in intensive care unit patients.MethodsAfter pre-registration (Open Science Framework: 8CUKF), we conducted a network meta-analysis with the following PICOS: adult patients (age > 18 years old) undergoing invasive mechanical ventilation admitted in ICU (P); any concentration of chlorhexidine used for oral hygiene (I); placebo, sham intervention, usual care, or no intervention (C); rate of VAP (primary outcome), mechanical ventilation length, ICU length of stay (LOS), hospital LOS, mortality (secondary outcomes) (O); randomized controlled trials (S). We used the following database: PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and EMBASE without any limitation in publication date or language.ResultsChlorhexidine did not demonstrate any significant advantage over the control group in preventing ventilator-associated pneumonia or reducing mortality, duration of mechanical ventilation, length of stay in the intensive care unit, or overall mortality.ConclusionsChlorhexidine oral decontamination does not reduce the rate of ventilator-associated pneumonia in critically ill adult patients and its routine use could not be recommended.Trial registrationRegistration number: Open Science Framework: 8CUKF.

Nurses’ Knowledge on the Prevention of Ventilator-Associated Pneumonia (VAP) among Critically Ill Patients

Background: Ventilator-associated pneumonia (VAP) is a significant concern in healthcare settings, particularly among critically ill patients who require mechanical ventilation. Nurses play a vital role in preventing VAP through their knowledge and implementation of evidence-based practices. However, there exists a notable gap in the research regarding nurses’ knowledge of preventing VAP to improve patient outcomes and reduce healthcare costs.Purpose: This study aimed to assess nurses’ knowledge of preventing VAP among critically ill patients using the ventilator bundle checklist.Methods: This study used a one-group pretest-posttest design to test the change in the nurses’ knowledge scores on VAP working in two government hospitals in Buraidah, Al Qassim Region, Saudi Arabia. The study covered 250 purposively and conveniently sampled nurses from intensive care units. Data collection was performed in three phases: pre-test, VAP educational program, and post-test. Data were collected using self-administered questionnaires on nurses’ socio-demographics, a 20-item self-made survey about the knowledge of VAP and its prevention and the adapted ventilator bundle checklist. The collected data were entered, prepared, and analyzed using SPSS version 25.0. Relevant ethical issues were strictly considered.Results: The results showed that during the pre-test, correct responses were accounted for but showed low scores in the following areas: general knowledge of VAP (27.6%), factors associated with VAP (36%), international guidelines for prevention (20.8%), and nurses’ roles in prevention (16.4%). However, in the post-test, there was a remarkable increase in the knowledge scores in the same categories (95.2%) on general knowledge, on factors associated with VAP (74.8%), on international guidelines (73.6%) and on nurses’ roles in prevention (61.6%). The program significantly improved overall VAP knowledge and knowledge in specific areas like general VAP, associated factors, international guidelines, and nurses’ roles in prevention (p<0.000).Conclusion: A pre-test revealed low baseline knowledge across all four areas assessed: general VAP knowledge, factors associated with VAP, international VAP prevention guidelines, and nurses’ roles in VAP prevention. However, post-test scores markedly increased in all areas, indicating the educational program’s effectiveness. Hence, the findings suggest that educational intervention focused on VAP screening and bundle protocols could be beneficial to address the gap in knowledge on VAP.

Compliance to ventilator care bundles and its association with ventilator-associated pneumonia

PurposeVentilator care bundles are effective in the prevention of ventilator-associated pneumonia (VAP). However, the compliance of these bundles in intensive care units (ICUs) remains poorly studied. This study investigates the Medical Information Mart for Intensive Care (MIMIC)-IV cohort’s compliance with the Institute for Healthcare Improvement (IHI) bundle and its resulting association with VAP incidence.MethodsThis is a retrospective cohort study of the MIMIC-IV database. Patients with > 48 h of invasive mechanical ventilation (IMV) were included. Diagnosis of VAP was identified with the International Classification of Diseases (ICD)-9 and ICD-10 codes. Compliance rates to the IHI bundle were extracted. The association of the IHI bundle and its individual interventions with VAP incidence was analyzed with univariate and multivariate analysis.Results8270 patients were included, of which 1328 (16.1%) had VAP. 25 patients (0.3%) had full compliance to the IHI bundle. 137 patients (1.7%) received no interventions from the bundle. Gastroprophylaxis had the lowest (2.1%) while head elevation had the highest (89.3%) compliance rates. In patients receiving the IHI bundle, each additional intervention was associated with lower VAP incidence (OR [odds ratio] = 0.906, 95% CI [confidence interval] 0.847–0.969). Appropriate sedation levels (OR = 0.765, 95% CI 0.661–0.885) and the use of heat and moisture exchanger (HME) filters (OR = 0.862, 95% CI 0.745–0.998) were individually associated with reduced VAP incidence, while active humidification was individually associated with increased VAP incidence (OR = 1.139, 95% CI 1.001–1.296).ConclusionThe use of the IHI bundle was associated with a lower incidence of VAP, but compliance with the bundle was poor. Appropriate sedation and HME filters were individually associated with reduced VAP incidence. Better compliance with the IHI bundle may reduce VAP rates in mechanically ventilated patients.Graphical

Use of nursing care bundles for the prevention of ventilator-associated pneumonia in low-middle income countries: A scoping review.

Ventilator-associated pneumonia (VAP) is a significant concern in low-middle-income countries (LMICs), where the burden of hospital-acquired infections is high, and resources are low. Evidence-based guidelines exist for preventing VAP; however, these guidelines may not be adequately utilized in intensive care units of LMICs. This scoping review examined the literature regarding the use of nursing care bundles for VAP prevention in LMICs, to understand the knowledge, practice and compliance of nurses to these guidelines, as well as the barriers preventing the implementation of these guidelines. The review was conducted using Arksey and O'Malley's (2005) five-stage framework and the PRISMA-ScR guidelines guided reporting. Searches were performed across six databases: CINAHL, Medline, Embase, Global Health, Scopus and Cochrane, resulting in 401 studies. After screening all studies against the eligibility criteria, 21 studies were included in the data extraction stage of the review. Across the studies, the knowledge and compliance of nurses regarding VAP prevention were reported as low to moderate. Several factors, ranging from insufficient knowledge to a lack of adequate guidelines for VAP management, served as contributing factors. Multiple barriers prevented nurses from adhering to VAP guidelines effectively, including a lack of audit/surveillance, absence of infection prevention and control (IPC) teams and inadequate training opportunities. This review highlights the need for adequate quality improvement procedures and more efforts to conduct and translate research into practice in intensive care units in LMIC. IPC practices are vital to protect vulnerable patients in intensive care units from developing infections and complications that worsen their prognosis. Critical care nurses should be trained and reinforced to practice effective bundle care to prevent VAP.

PROBIOTICS FOR THE PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA

Ventilator-associated pneumonia is associated with a high rate of all-cause mortality and a prolonged duration of mechanical ventilation and intensive care unit stay. Ventilator associated pneumonia accounts for about half of all antibiotics given in the intensive care unit. Plenty of studies have assessed various kinds of prevention strategies, including pharmacological and non-pharmacological interventions, to prevent ventilator-associated pneumonia over the years. An emerging number of studies has assessed the non-antibiotic approaches for the prevention of ventilator-associated pneumonia in the last few years. One of the frequently used strategy is addition of probiotics in the preventive measures list. Regular consumption of probiotics can modulate immune responses and metabolic processes as well as antioxidant and anti-inflammatory effects. The strongest evidence in favor of probiotics lies in the prevention or treatment of necrotizing enterocolitis, acute infectious diarrhea, acute respiratory tract infections, antibiotic-associated diarrhea, and infant colic. The beneficial effects of probiotics in the prevention of ventilator-associated pneumonia were not yet entirely clarified. Multiple pieces of evidence indicate that the bacteria that populate the gut efficiently modulate the immune response. Treatment with probiotics have shown promising preliminary results to attenuate systemic inflammation, especially in postoperative infections and ventilation performance. This review aims to summarize latest data on the use probiotics to prevent ventilator-associated pneumonia in critical care unit.

Measuring evidence-based clinical guideline compliance in the paediatric intensive care unit

BackgroundEvidence-based clinical care guidelines improve medical treatment by reducing error, improving outcomes and possibly lowering healthcare costs. While some data exist on individual guideline compliance, no data exist on overall...

Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis.

This study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients. Relevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence. We identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P < 0.001), although considerable heterogeneity was observed (I2 = 71%). Conducting trial sequential analysis confirmed the finding, and the GRADE level was moderate. Subgroup analysis demonstrated that CCCP combined with subglottic secretion drainage (SSD) had a more significant effect on reducing VAP (RR = 0.39; 95% CI = 0.29-0.52; P < 0.001). The effect of CCCP on ventilator-associated respiratory infection (VARI) incidence was uncertain (RR = 0.81; 95% CI = 0.53-1.24; P = 0.34; I2 = 61%). Additionally, CCCP significantly reduced the duration of mechanical ventilation (MV) (mean difference [MD] = -2.42 days; 95% CI = -4.71-0.12; P = 0.04; I2 = 87%). Descriptive analysis showed that CCCP improved the qualified rate of cuff pressure. However, no significant differences were found in the length of intensive care unit (ICU) stay (MD = 2.42 days; 95% CI = -1.84-6.68; P = 0.27) and ICU mortality (RR = 0.86; 95% CI = 0.74-1.00; P = 0.05). Our findings suggest that the combination of CCCP and SSD can reduce the incidence of VAP and the duration of MV and maintain the stability of cuff pressure. A combination of CCCP and SSD applications is suggested for preventing VAP.

Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios.

To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB. Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments. The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. Experts participated in the Delphi rounds and nurses in the pilot test.

Oral Care and Positioning to Prevent Ventilator-Associated Pneumonia: A Systematic Review.

Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in critical patients. The negative impacts of VAP on patient outcomes emphasize the importance of effective preventive measures such as oral care and patient positioning. The aim of this review was to investigate the impact of oral care and positioning on the prevention of VAP among patients in the intensive care unit. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed. The methodological quality of included studies was appraised using Joanna Briggs Institute checklists. In total 13 studies were included, all of them were randomized controlled trials. Six out of nine studies about oral care have significant results on VAP incidence. Regarding the position, Patients positioned at a 45-degree were less likely to develop VAP than those positioned at a 30-degree and those in a supine position. Although patients positioned at 45-degree angle were less likely to develop VAP than those at 30-degree, it is necessary to individualize this practice before recommending it, once there are some contraindications, such as neurocritical patients. Regarding oral care to prevent VAP, considering the current guidelines' recommendation not to use oral chlorexidine, further studies evaluating alternatives are needed.

Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial

Patients with acute brain injury are at high risk of ventilator-associated pneumonia (VAP). The benefit of short-term antibiotic prophylaxis remains debated. We aimed to establish the effect of an early, single dose of the antibiotic ceftriaxone on the incidence of early VAP in patients with severe brain injury who required mechanical ventilation. PROPHY-VAP was a multicentre, randomised, double-blind, placebo-controlled, assessor-masked, superiority trial conducted in nine intensive care units in eight French university hospitals. We randomly assigned comatose (Glasgow Coma Scale score [GCS] ≤12) adult patients (age ≥18 years) who required mechanical ventilation for at least 48 h after acute brain injury to receive intravenous ceftriaxone 2 g or placebo once within the 12 h following tracheal intubation. Participants did not receive selective oropharyngeal and digestive tract decontamination. The primary outcome was the proportion of patients developing early VAP from the 2nd to the 7th day of mechanical ventilation, confirmed by masked assessors. The analysis was reported in the modified intention-to-treat population, which comprised all randomly assigned patients except those who withdrew or did not give consent to continue and those who did not receive the allocated treatment because they met a criterion for non-eligibility. The trial is registered with ClinicalTrials.gov, NCT02265406. From Oct 14, 2015, to May 27, 2020, 345 patients were randomly assigned (1:1) to receive ceftriaxone (n=171) or placebo (n=174); 330 received the allocated intervention and 319 were included in the analysis (162 in the ceftriaxone group and 157 in the placebo group). 166 (52%) participants in the analysis were men and 153 (48%) were women. 15 patients did not receive the allocated intervention after randomisation and 11 withdrew their consent. Adjudication confirmed 93 cases of VAP, including 74 early infections. The incidence of early VAP was lower in the ceftriaxone group than in the placebo group (23 [14%] vs 51 [32%]; hazard ratio 0·60 [95% CI 0·38-0·95], p=0·030), with no microbiological impact and no adverse effects attributable to ceftriaxone. In patients with acute brain injury, a single ceftriaxone dose decreased the risk of early VAP. On the basis of our findings, we recommend that an early, single dose of ceftriaxone be included in all bundles for the prevention of VAP in patients with brain injury who require mechanical ventilation. French Ministry of Social Affairs and Health.

Knowledge of ICU nurses toward prevention of ventilator associated pneumonia at public hospitals in Najran, Saudi Arabia

Objective: To assess the level of knowledge among Intensive Care Unit nurses regarding Ventilator-associated pneumonia prevention at Najran Hospital in Najran City, Saudi Arabia. Methodology: This descriptive cross-sectional study was conducted among Intensive Care Unit nurses at Najran Hospital using stratified random sampling from four major government hospitals. Data were collected from 1st February to 30th April 2019, through structured questionnaires from 147 nurses. Descriptive and inferential statistics were applied using SPSS version 21. Results: The participants were primarily female (54%), married (50.6%), with a mean age of 28.4±4.2 years. A significant proportion (55.2%), had 1-3 years of Intensive Care Unit experience and the majority held diploma degrees (65.5%). More than half received Intensive Care Unit training (51.7%) and 81.6% had not undergone specific Ventilator-associated pneumonia prevention training. Only 5.7% of Intensive Care Unit nurses demonstrated good knowledge of Ventilator-associated pneumonia prevention, 57.5% exhibited moderate knowledge, and 36.8% had poor knowledge. No significant associations were found between knowledge levels and Intensive Care Unit training, gender, or years of experience (p&gt;0.05). However, a significant correlation was observed between the level of education and knowledge of Ventilator-associated pneumonia prevention (p=0.001). Conclusion: The study highlights substantial knowledge gaps among Intensive Care Unit nurses concerning Ventilator-associated pneumonia prevention, with the majority demonstrating inadequate knowledge. Urgent interventions are required to enhance the understanding of Ventilator-associated pneumonia prevention among Intensive Care Unit nursing staff.

Prevention of ventilator-associated pneumonia with inhaled antibiotics

Prevention of ventilator-associated pneumonia with inhaled antibiotics

Advancements in Oral Hygiene Practices for the Prevention of Ventilator-Associated Pneumonia

Advancements in Oral Hygiene Practices for the Prevention of Ventilator-Associated Pneumonia

Herbal oral care products for the prevention of ventilator-associated pneumonia: A systematic review and network meta-analysis of randomised trials.

The recommendation for Chlorhexidine (CHX) as a traditional oral care solution is decreasing, and herbal oral care products are being considered as a potential alternative. This network meta-analysis aims to determine if herbal oral care products for oral care in mechanically ventilated patients are superior to CHX and provide direction for future research by comparing the effectiveness of herbal oral care products currently available. We searched for English-language published and grey literature sources of randomized clinical trials involving herbal oral care solutions in intensive care unit (ICU) oral care (until September 2023). The primary outcome was the incidence of ventilator-associated pneumonia (VAP); the secondary outcome was the oral microbiota quantity. Data were pooled by pairwise meta-analysis and Bayesian network meta-analysis. The risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence was evaluated using the GRADE framework. Our network meta-analysis included 29 studies, and the results showed that Chinese herb (OR: 0.39, 95% CI: 0.2-0.75) and Miswak (OR: 0.27, 95% CI: 0.07-0.91) were more effective in reducing VAP incidence than CHX. In terms of reducing bacterial counts, Chinese herb (OR: 0.3, 95% CI: 0.19-0.48) was superior to CHX, and all herbal oral care products, including Persica® (alcoholic extract of S. persica, Achillea millefolium, and Mentha spicata), Matrica® (Chamomile extract), and Listerine® (main components include Menthol, Thymol, and Eucalyptol), were better than saline in all aspects but without significant differences. Based on our network meta-analysis, we have observed that Chinese herbal medicine and Miswak are superior to CHX in reducing the incidence of VAP. However, the safety and feasibility of traditional Chinese herbal medicine require further high-quality research for validation. Simultaneously, Matrica® demonstrates a significant reduction in microbial counts but does not exhibit a significant advantage in lowering the incidence of VAP. This observation aligns with the results of clinical double-blind trials. Therefore, we identify Miswak and Matrica® as promising herbal oral care products with the potential to replace CHX. It is essential to emphasize that our study provides guidance for future research rather than conclusive determinations. PROSPERO no. CRD42023398022.

The Impact of Nursing Education on Ventilator-Associated Pneumonia Prevention Bundle to Reduce Incidence of Infection: A Quality Improvement Project.

Ventilator-associated pneumonia (VAP) is a health care-acquired infection that leads to poor patient outcomes, increased length of hospital stay, exhaustion of health care resources, and unnecessary increases in health care costs. This project was designed to educate registered nurses on the importance of an evidence-based VAP prevention bundle that reduces the overall incidence of VAP infections. Patients (N = 146) were enrolled in this quasi-experimental project that took place in a 14-bed neuro trauma surgical burn intensive care unit (ICU) at a level 1 trauma center. Data were collected from the chart review of patients admitted to the neuro trauma surgical burn ICU prior to and after nursing education intervention. The difference in VAP rate and enhanced nursing knowledge were the primary outcome measures. Data suggest improvement in several patient outcomes. Ventilator days were shortened from 17.45 days to 13.42 days (P = .085), and ICU length of stay decreased from 24.77 days to 17.62 days (P = .035). Patient laboratory data show improved white blood cell values (P < .001), less oxygen requirements (P < .001), and fewer patients meeting the diagnostic criteria for VAP (P = .073). Results suggest there were no statistically significant changes in the knowledge of registered nurses or oral care bundle compliance; however, improvements in patient data following the provider education suggest that continued education to nursing staff will have a positive impact on reducing hospital stay and significant costs associated with a VAP infection.

The Effect of Ventilator-Associated Pneumonia Prevention Bundles on Ventilator-Associated Event Rate in the Intensive Care Units of a Tertiary Care Hospital

Amaç: Ventilatör ilişkili pnömoni (VİP) önlem demetlerine uyum ile VİP insidansının azaldığı gösterilmiştir. Ancak bu demetlerin Ventilatör ilişkili olay (VİO) insidansına olan etkisi hala tartışmalıdır. Bu çalışmanın amacı, bir eğitim araştırma hastanesinin yoğun bakım ünitelerinde (YBÜ) belirli bir dönemdeki VİO insidansı ve VİP önleme demetine uyumun araştırılmasıdır. Materyal ve metod: Bu çalışma, üçüncü basamak bir eğitim ve araştırma hastanesinin YBÜ’ lerinde Nisan - Haziran 2019 arasında VİO insidansı ve VİP önleme demetlerine uyumun araştırıldığı prospektif gözlemsel bir vaka kontrol çalışmasıdır. VİP önleme demeti oluşturuldu; VİO insidansı ise 2013 Amerika Birleşik Devletleri Hastalık Kontrol ve Önleme Merkezi (CDC) sürveyans kriterlerine göre belirlendi. Hasta özelliklerinin ve YBÜ’ lerdeki hasta dağılımının ve VİO gelişimi üzerine etkileri araştırıldı. Bulgular: Araştırma 98 hasta ile tamamlandı. VİP önleme demetlerine uyum oranının YBÜ’ ler arasında %65 ile %85 arasında değiştiği saptandı. VİP önleme demetine uyumdaki her %10 azalmanın VİO gelişme riskini artırdığı diğer önemli risk faktörleri ile gösterildi. Sonuç: Hastanemiz YBÜ’ lerinde 2013 CDC kriterlerine göre VIO insidansı %20,4’tür. VIO gelişme riski, VİP önleme demetine düşük uyum, hasta özellikleri ve YBÜ tedavilerinden kaynaklanan birçok faktör ile artmaktadır. YBÜ’ lerinde VİP önlem demetlerine uyum bakımından farklılıklar konu ile ilgili eğitim faaliyetlerinin gerekliliğini göstermektedir.

Prevention of Ventilator-associated Pneumonia: Knowledge and Practice of Ventilator Care Bundle among ICU Nurses of Tertiary Care Hospitals of Jodhpur, Rajasthan

Prevention of Ventilator-associated Pneumonia: Knowledge and Practice of Ventilator Care Bundle among ICU Nurses of Tertiary Care Hospitals of Jodhpur, Rajasthan

Prevalence of Ventilator-Associated Pneumonia in Children Admitted to Pediatric ‎Intensive Care Units in the Middle East: A Systematic Review.

Ventilator-associated pneumonia (VAP) is a common healthcare-associated disease in intensive care units, leading to significant morbidity and mortality. This systematic review aims to investigate the prevalence, risk factors, and prevention strategies for VAP in the Middle East. PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar were systematically searched to include the relevant literature. Rayyan QCRI was used throughout this systematic approach. Ten studies, involving a total of 6295 patients diagnosed with VAP, were included in this review. Among these patients, 336 (5.3%) developed VAP. The prevalence of VAP in children and neonates in the Middle East was relatively low. Risk factors associated with VAP development included prematurity, low birth weight, prolonged mechanical ventilation, enteral feeding, intrusive devices such as umbilical catheters, and cardiac operations. All reviewed studies emphasized the importance of infection control measures in reducing the risk of VAP.

The global epidemiology of ventilator-associated pneumonia caused by multi-drug resistant Pseudomonas aeruginosa: a systematic review and meta-analysis.

ObjectiveThe objective of this systematic review and meta-analysis was to estimate the global prevalence of multi-drug resistant (MDR) Pseudomonas aeruginosa causing ventilator-associated pneumonia (VAP). MethodsThe systematic search was conducted in four databases. Original studies describing MDR P. aeruginosa VAP prevalence in adults from 2012 to 2022 were included. Meta-analysis, using the random effects model, was conducted for overall, subgroups (country, published year, study duration, and study design), and European data, respectively. Univariate meta-regression based on pooled estimates was also conducted. Systematic review registered in PROSPERO (CRD42022384035). ResultsThirty-one studies, containing a total of 7,951 cases from 16 countries, were included. The overall pooled prevalence of MDR among P. aeruginosa causing VAP was 33% (95% CI 27.7%-38.3%). The highest prevalence was for Iran 87.5% (95% CI 69%-95.7%), and the lowest was for the USA 19.7% (95% CI 18.6%-20.7%). The European prevalence was 29.9% (95% CI 23.2%-36.7%). ConclusionThis review indicates that the prevalence of MDR P. aeruginosa in VAP patients is generally high and varies significantly between countries, however data are insufficient for many countries. The data in this study can provide a reference for VAP management and drug customisation strategies .

Effect of Trachyspermum ammi Syrup on the Prevention of Ventilator-Associated Pneumonia

IntroductionVentilator-associated pneumonia (VAP) is a dangerous nosocomial infection. Due to the spread of multidrug-resistant bacteria and the increase in antibiotic resistance, many researchers have focused on the antimicrobial effects of plants and their extracts. This clinical trial examined the effect of Trachyspermum ammi (T ammi) syrup on VAP. MethodsIn this study, the intervention group patients (49 people) received 10 ml of T ammi syrup 10% three times a day from the first 24 hours of gavage for 10 days. Patients in the placebo group (n = 49) received placebo syrup in the same way. Finally, VAP was measured on day 10 based on the Modified Clinical Criteria for the Pulmonary Infections checklist. ResultsThe results revealed that 10 (20.4%) patients in the T ammi group and 15 (30.6%) patients in the placebo group developed VAP. The odds of developing VAP in the placebo group were 72% higher than in the T ammi group, but this ratio was not statistically significant (odds ratio = 1.72, P = 0.24). ConclusionsIt is suggested that future studies should examine the effect of different doses of T ammi and other herbal medications on developing VAP.