Objective: To determine if VAP rates in 154 intensive care units (ICUs) of 25 limited resources countries are significantly affected by the country socio-economic level (Low Income; Middle Low Income, and Middle High Income) and by the hospital type (Academic, Public or Private).
Methods: A prospective cohort, active VAP surveillance study was conducted on adult and pediatric patients admitted to 154 tertiary-care ICUs of 25 low, middle low, and middle high income countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, Greece, India, Jordan, Kosovo, Lebanon, Lithuania, Macedonia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Salvador, Thailand, Tunisia, Turkey, Venezuela and Vietnam. The protocol and methodology were developed by INICC. Data collection was done in the participating ICU. Data uploading and analysis were done at INICC headquarters. Rates of DAI were recorded through applying the definitions provided by the CDC NNIS/NHSN system. Epi Info 6.04b and SPSS 16.0 were used for epidemiological and statistical data analysis. We analyzed the VAP rates by socio-economic level according to the World Bank categorization (Low income; middle low income, and middle high income) and by hospital type (Public, Academic, and Private) and compared the results calculating device associated rates per 1000 devices, and 95% confidence intervals.
Results: From January 2003 to December 2008, at this study 236,980 patients were enrolled from 25 limited resources countries. VAPs rates were calculated stratified by socio economic level of the country, and type of hospital. Overall VAP rate in low income countries was 13.7 VAPs per 1000 device-days (95% CI, 12.4-14.9); in middle-low income countries was 13.0 (95% CI, 12.3-13.7); and in middle-high income countries was 13.9 (95% CI, 13.4-14.3). Overall VAP rate at academic hospitals was 13.8 VAPs per 1000 device-days (95% CI, 13.3-14.2); at public hospitals was 20.9 (95% CI, 19.8-20.0); and at private hospitals was 7.0 (95% CI, 6.4-7.7).
Conclusions: Low income countries have similar VAP rate than middle income countries. Private hospitals have a VAP rate significantly lower than public or academic hospitals; and academic hospitals have a VAP rate significantly lower than public hospitals.