■呼吸机相关性肺炎(VAP)是印度接受机械通气患者发病和死亡的主要原因。VAP的监测对于实施基于数据的预防措施至关重要。实施呼吸机相关事件(VAE)监测标准对低资源设置有主要限制。这可能导致严重的漏报。在大型医院网络中使用通用协议对VAP进行监视将对低资源环境中的VAP负担进行有意义的估计。这项研究利用了先前建立的医疗保健相关感染(HAI)监视网络,以开发和测试针对印度环境进行调整的修改后的VAP定义。
■在这项观察性试点研究中,在2021年2月至2023年4月期间,从现有的HAI监测网络中选择了13家医院来开发和测试修改后的VAP定义.用于诊断VAP的标准根据CDC的儿科VAP定义进行了修改,并根据印度医院的需求进行了修改。指定护士在病例报告表(CRF)中记录每个VAP事件,并收集分母数据。将数据输入到本地开发的数据库中进行验证和分析。在数据分析的时候,我们向研究中心发送了一份调查问卷,以获取有关修改后的VAP定义的性能的反馈.
■在133,445个患者日和40,533个呼吸机日中,记录了261例VAP事件,总VAP率为6.4/1000呼吸机天,设备利用率(DUR)为0.3。从VAP事件中报告了总共344个生物体。其中,不动杆菌属(29.6%,102)是最常见的,其次是克雷伯菌属(26.7%,92).不动杆菌(98%)和肠杆菌(85.5%)的分离株对碳青霉烯具有很高的耐药性。在6%的肠杆菌和3.2%的不动杆菌属中观察到粘菌素耐药性。
■本试点研究的数据需要在较大的印度HAI监视网络中进行验证,以便它可以帮助更广泛地实施本协议,以便评估其在整个印度的VAP适用性。
■这项工作得到了印度医学研究委员会(代码I-1203)的资助。
UNASSIGNED: Ventilator-associated pneumonia (
VAP) is a major cause of morbidity and mortality in patients receiving mechanical ventilation in India. Surveillance of
VAP is essential to implement data-based preventive measures. Implementation of ventilator-associated events (VAE) criteria for surveillance has major constraints for low resource settings, which can lead to significant underreporting. Surveillance of VAP using common protocols in a large network of hospitals would give meaningful estimates of the burden of
VAP in low resource settings. This study leverages a previously established healthcare-associated infections (HAI) surveillance network to develop and test a modified VAP definition adjusted for Indian settings.
UNASSIGNED: In this observational pilot study, thirteen hospitals from the existing HAI surveillance network were selected for developing and testing a modified VAP definition between February 2021 and April 2023. The criteria used for diagnosing
VAP were adapted from the CDC\'s Pediatric
VAP definition and modified to cater to the needs of Indian hospitals. Designated nurses recorded each VAP event in a case report form (CRF) and also collected denominator data. The data was entered into an indigenously developed database for validation and analysis. At the time of data analysis, a questionnaire was sent to sites to get feedback on the performance of the modified VAP definitions.
UNASSIGNED: Out of 133,445 patient days and 40,533 ventilator days, 261 VAP events were recorded, with an overall VAP rate of 6.4 per 1000 ventilator days and a device utilization ratio (DUR) of 0.3. A total of 344 organisms were reported from the
VAP events. Of these, Acinetobacter spp (29.6%, 102) was the most frequent, followed by Klebsiella spp (26.7%, 92). Isolates of Acinetobacter spp (98%) and Enterobacterales (85.5%) showed very high resistance against Carbapenem. Colistin resistance was observed in 6% of Enterobacterales and 3.2% of Acinetobacter spp.
UNASSIGNED: Data from this pilot study needs to validated in the larger Indian HAI surveillance network so that it can help in wider implementation of this protocol in order to assess its applicability p VAP across India.
UNASSIGNED: This work was supported by a grant received from the Indian Council of Medical Research (code I-1203).