A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology.
Bonell, Ana;
Azarrafiy, Ryan;
Huong, Vu Thi Lan;
Viet, Thanh Le;
Phu, Vu Dinh;
Dat, Vu Quoc;
Wertheim, Heiman;
van Doorn, H Rogier;
Lewycka, Sonia;
Nadjm, Behzad;
(2018)
A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 68 (3).
pp. 511-518.
ISSN 1058-4838
DOI: https://doi.org/10.1093/cid/ciy543
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BACKGROUND: Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. METHODS: We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. RESULTS: Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). CONCLUSIONS: VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.