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2180. Incidence and Outcomes of Ventilator-Associated Events, Utilising Centre for Disease Control Criteria in a Tertiary Intensive Care Unit, Victoria, Australia

, BBiomedSc, BSc (Hons), MBBS (Hons), MPH 1 , , MBBS, FRACP, PhD 1 , 2 , , MBChB, FRACP, FCICM 3 , , MBBS, FCICM 3 , , MBBS, FRACGP, PhD 2 , 4 , , BN, CCRN 3 , , MBBS, PhD, FRACP, GradDipClinEpi 1 , 2 , , MBBS, MD, PGDipEcho, FRACP, FCICM, AFRACMA 3 , 5 , 6 , , MBBS, FRACP, MD 1 , 2 , 4

Open Forum Infectious Diseases

Oxford University Press

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      Abstract

      Background

      Ventilator-associated pneumonia (VAP) is a common complication of admission to intensive care units (ICU), and may be associated with significant morbidity, mortality and healthcare cost. While VAP surveillance is a desirable element of ICU infection prevention programmes, the lack of an easily applicable definition, providing accurate and clinically meaningful data limits implementation. We aimed to conduct a pilot study of ventilator associate event (VAE) surveillance, per Centre for Disease Control National Healthcare Safety Network (CDC NHSN) criteria, to describe the incidence, and outcomes for patients with VAE in our setting.

      Methods

      We conducted a prospective cohort study in our 24-bed mixed tertiary ICU in Melbourne, Australia. Adult patients requiring mechanical ventilation for ≥2 days between March and October, 2015, were included. We collected detailed clinical and laboratory data, including antibiotic duration and indication, and ICU and hospital length of stay. We applied the CDC NHSN criteria.

      Results

      We included 202 patients (median age 58.1 ± 17.8 years, 32.7% female, 73% medical), over 1,390 ventilator days. Ventilator associated condition (VAC) occurred in 33 (16.3%) patients (23.7 per 1,000 ventilator days), Infection-related VAC (IVAC) in 15 (7.4%) patients (10.7 per 1,000 ventilator days), and possible VAP (PVAP) in 8 (3.9%) patients (5.75 per 1,000 ventilator days). In contrast, clinician-diagnosed VAP (CD-VAP) occurred in 37 (18.3%) patients (26.6 per 1,000 ventilator days). Patients with VAC had a greater median number of ventilator days (12 vs. 4, P < 0.001), ICU length of stay (LOS) (17 vs. 6 days, P < 0.005), hospital LOS (30 vs. 19 days, P = 0.005), and antibiotic days (12 vs. 5, P < 0.001), than those without VAC. CD-VAP was associated with VAC (OR 4.7, 95% CI 2.1–10.6, P < 0.001), but agreement was poor (kappa 0.29). The overall sensitivity of VAC for CD-VAP was 38%, specificity was 89%, PPV 48%, NPV 85%, while for PVAP these were 17, 99, 88 and 82%, respectively.

      Conclusion

      VAC is associated with important, measurable surveillance outcomes, but the agreement, sensitivity and predictive value of these criteria for CD-VAP are poor. Hence the CDC criteria may miss clinically important healthcare-associated infections and may not capture the most appropriate target group for VAP prevention.

      Disclosures

      All authors: No reported disclosures.

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      Author and article information

      Affiliations
      [1 ]Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Australia
      [2 ]The Peter Doherty Institute, Parkville, Australia
      [3 ]Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Australia
      [4 ]Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Parkville, Australia
      [5 ]Epworth Healthcare, Richmond, Australia
      [6 ]Department of Health and Human Services (DHHS), Critical Care Clinical Network, Safer Care Victoria, Melbourne, Australia
      Journal
      Open Forum Infect Dis
      Open Forum Infect Dis
      ofid
      Open Forum Infectious Diseases
      Oxford University Press (US )
      2328-8957
      November 2018
      26 November 2018
      26 November 2018
      : 5
      : Suppl 1 , ID Week 2018 Abstracts
      : S643-S644
      6254021 10.1093/ofid/ofy210.1836 ofy210.1836
      © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

      This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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