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Trends of Incidence and Risk Factors of Ventilator-Associated Pneumonia in Elderly Patients Admitted to French ICUs Between 2007 and 2014*

Dananché, Cédric PharmD, MSc1,2; Vanhems, Philippe MD, PhD1–3; Machut, Anaïs MSc3; Aupée, Martine MD4; Bervas, Caroline PharmD5; L’Hériteau, François MD6; Lepape, Alain MD2,7; Lucet, Jean-Christophe MD, PhD8,9; Stoeckel, Vincent MD10; Timsit, Jean-François MD, PhD9,11; Berger-Carbonne, Anne MD, PhD12; Savey, Anne MD2,3; Bénet, Thomas MD, PhD1,2; for the Healthcare-Associated Infections (HAIs) Surveillance Network of ICUs (Réseau REA-Raisin)

doi: 10.1097/CCM.0000000000003019
Clinical Investigations
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Objectives: To assess trends and risk factors of ventilator-associated pneumonia according to age, particularly in the elderly admitted to French ICUs between 2007 and 2014.

Design: Multicenter, prospective French national Healthcare-Associated Infection surveillance network of ICUs (“Réseau REA-Raisin”).

Settings: Two-hundred fifty six ICUs in 246 settings in France.

Patients: Included were all adult patients hospitalized greater than or equal to 48 hours in ICUs participating in the network.

Interventions: Ventilator-associated pneumonia surveillance over time.

Measurements and Main Results: Overall and multidrug-resistant organism–related ventilator-associated pneumonia incidence rates were expressed per 1,000 intubation days at risk. Age was stratified into three groups: young (18–64 yr old), old (65–74 yr old), and very old (75+ yr old). Age-stratified multivariate mixed-effects Poisson regressions were undertaken to assess trends of ventilator-associated pneumonia incidence over time, with center as the random effect. Ventilator-associated pneumonia risk factors were also evaluated. Of 206,223 patients, 134,510 were intubated: 47.8% were young, 22.3% were old, and 29.9% were very old. Ventilator-associated pneumonia incidence was lower in the very old group compared with the young group (14.51; 95% CI, 16.95–17.70 vs 17.32; 95% CI, 16.95–17.70, respectively, p < 0.001). Methicillin-resistant Staphylococcus aureus and third-generation cephalosporin-resistant Enterobacteriaceae were identified more frequently in very old patients (p < 0.001 and 0.014, respectively). Age-stratified models disclosed that adjusted ventilator-associated pneumonia incidence decreased selectively in the young and old groups over time (adjusted incidence rate ratios, 0.88; 95% CI, 0.82–0.94; p < 0.001 and adjusted incidence rate ratios, 0.95; 95% CI, 0.86–1.04; p = 0.28, respectively). Male gender and trauma were independently associated with ventilator-associated pneumonia in the three age groups, whereas antibiotics at admission was a protective factor. Scheduled surgical ICU and immunodeficiency were risk factors of ventilator-associated pneumonia in the old group (p = 0.003).

Conclusions: Ventilator-associated pneumonia incidence is lower but did not decrease over time in very old patients compared with young patients.

1Service d’Hygiène, Épidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon (HCL), Lyon, France.

2Équipe Épidémiologie et Santé Internationale, Laboratoire des Pathogènes Émergents – Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique Unité Mixte de Recherche 5308, École Nationale Supérieure de Lyon, Université Claude Bernard Lyon 1, Lyon, France.

3Centre d’appui pour la prévention des infections associées aux soins (CPIAS) Auvergne-Rhône-Alpes, HCL, Lyon, France.

4CPIAS Bretagne, Centre Hospitalier Universitaire (CHU), Rennes, France.

5CPIAS Nouvelle Aquitaine, CHU, Bordeaux, France.

6CPIAS Ile de France, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

7Département de Soins Critiques et Recherche Clinique, Groupement Hospitalier Sud, HCL, Lyon, France.

8Unité d’Hygiène et de Lutte contre l’Infection Nosocomiale (UHLIN), Hôpital Bichat-Claude Bernard, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

9IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.

10CPIAS Grand Est, CHU, Nancy, France.

11Service de réanimation médicale, Hôpital Bichat, AP-HP, Paris, France.

12Département des Maladies Infectieuses, Santé Publique France (Institut de Veille Sanitaire), Saint-Maurice, France.

*See also p. 1007.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

This Réseau REA-Raisin project was funded by an annual grant from the National Public Health Agency (Santé Publique France).

Dr. Dananché received support for article research from the French National Public Health Agency (Santé Publique France). Dr. Vanhems received funding from CemKal-Eval, GSK, and Astellas. Dr. Bervas received support for article research from the National Institutes of Health. Dr. Savey’s institution received funding from the National Public Health Agency (Santé Publique France). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: cedric.dananche@chu-lyon.fr

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