982 International Nosocomial Infection Control Consortium report, data summary for 2003-2008: Impact of socio economic level of the country and type of hospital on VAP rates in Adult and Pediatric ICUs of 25 limited resources countries

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Victor D. Rosenthal , INICC, Buenos Aires, Argentina
Badaruddin A. Memon , Department of Microbiology,S.A.L. University Khairpur, Khairpur, Pakistan
Visanu Thamlikitkul , Siriraj Hospital, Mahidol University, Bangkok, Thailand
Tarquino Erástides G. Sánchez , Hospital Anchieta LTDA, Taguatinga, Brazil
F. E. Udwadia , Breach Candy Hospital Trust, Mumbai, India
Nayide Barahona Guzmán , Universidad Simón Bolivar, Barranquilla, Colombia
Grülden Ersoz , Mersin University, Faculty of Medicine, Mersin, Turkey
Ilham Abu Khader , Jordan University Hospital, Amman, Jordan
Martha Sobreyra Oropeza , Hospital de la Mujer, Mexico City, Mexico
Regina Berba , Philippine General Hospital, Manila, Philippines
Fernando Martín Ramírez Wong , Hospital María Auxiliadora, Lima, Peru
Naoufel Madani , Ibn Sina, Rabat, Morocco
Osiel Requejo Pino , Hospital Universitario Gral. Calixto García, Havana, Cuba
Lourdes Dueñas , Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Zan Mitrev , Filip II Special Cardiosurgery Hospital, Skopje, Macedonia
Bijie Hu , Zhongshan Hospital, Shangai, China
Vaidotas Gurskis , Kaunas University of Medicine, Children Clinic, Kaunas, Lithuania
SS Kanj , American University of Beirut Medical Center, Beirut, Lebanon
Trudell Mapp , Clínica Hospital San Fernando, Panama, Panama
Rosalía Fernández Hidalgo , Hospital Clínica Bíblica, San Jose, Costa Rica
Nejla Ben Jaballah , Hôpital d'Enfants, Tunis, Tunisia
Lul Raka , National Institute for Public Health of Kosova and Medical School, Prishtina University, Prishtina, Serbia and Montenegro
Le Thi Anh Thu , Cho Ray Hospital, Ho Chi Minh City, Vietnam
Achilleas Gikas , University Hospital of Heraklion, Heraklion, Greece
María Eugenia Guzmán Siritt , Hospital Militar Dr. Carlos Arvelo, Caracas, Venezuela
Background: Ventilator associated pneumonia (VAP) rates in limited resources countries are significantly higher than international standards of developed countries; but is it not known if the socio economic level of the limited resources countries and the hospital type are associated with a different VAP rate.

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.