Background Intubator-Associated Pneumonia (IAP) is a common healthcare-associated infection with significant mortality, morbidity and healthcare costs, and rates have been proposed as a potential quality indicator. An increase in the IAP rates was shown by the “Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network” (SPIN-UTI) (Agodi et al., 2013). The aim of the present study was to estimate the preventable proportion (PP) of IAPs in ICUs participating in the fourth edition of the SPIN-UTI project. Methods From October 2012 to July 2013 patient-based surveillance data were collected according to the ECDC HAIICU protocol (vs. 1.2). Using the parametric G-formula for time-to-event data, we estimated the expected number of IAP and the IAP incidences that would be realized if ICUs with higher IAP incidence rates in the database had the same IAP incidence of reference ICUs (the top 10th percentile ranked ICU for the IAP incidence distribution), after adjustment (i.e. standardization) for patients and ICU characteristics. The PP of IAP was calculated as observed cases minus expected cases divided by observed cases. Results A total of 1840 intubated patients from 17 ICUs were enrolled. Overall, IAP incidence was 11.7 per 100 intubated patients and IAP rate was 11.8 per 1000 intubator-days. In the unadjusted model the PP of IAP was 0.82 (CI95%: 0.78-0.86); the PP was 0.47 (CI95%: 0.40-0.54) after standardization for case-mix. Conclusions Based on European surveillance data collected by the National ICU networks, more than 52% of ventilator-associated pneumonia could have been avoided (Lambert et al, 2014). Similarly, in the SPIN-UTI network, if IAP rates of ICUs with higher infection rates could have been reduced to that of the 10th percentile-ranked ICUs, then about 47% of IAPs could have been prevented by the implementation of preventive measures. Project realized with financial support by Ministry of Health – CCM.
Preventable proportion of Intubator-Associated Pneumonia in Italian Intensive Care Units: a G-computation analysis / Agodi, Antonella; Barchitta, Martina; Quattrocchi, Annalisa; Spera, Emiliano; Gallo, Giovanni; Auxilia, Francesco; Brusaferro, Silvio; D'Errico, Marcello Mario; Montagna, Maria Teresa; Pasquarella, Cesira; Tardivo, Stefano; Mura, Ida. - In: EUROPEAN JOURNAL OF PUBLIC HEALTH. - ISSN 1101-1262. - ELETTRONICO. - 26:(2016). (Intervento presentato al convegno 9th European Public Health Conference. All for Health, Health for All tenutosi a Vienna nel 9-12 novembre 2016) [http://dx.doi.org/10.1093/eurpub/ckw174.249].
Preventable proportion of Intubator-Associated Pneumonia in Italian Intensive Care Units: a G-computation analysis
D'ERRICO, Marcello Mario;
2016-01-01
Abstract
Background Intubator-Associated Pneumonia (IAP) is a common healthcare-associated infection with significant mortality, morbidity and healthcare costs, and rates have been proposed as a potential quality indicator. An increase in the IAP rates was shown by the “Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network” (SPIN-UTI) (Agodi et al., 2013). The aim of the present study was to estimate the preventable proportion (PP) of IAPs in ICUs participating in the fourth edition of the SPIN-UTI project. Methods From October 2012 to July 2013 patient-based surveillance data were collected according to the ECDC HAIICU protocol (vs. 1.2). Using the parametric G-formula for time-to-event data, we estimated the expected number of IAP and the IAP incidences that would be realized if ICUs with higher IAP incidence rates in the database had the same IAP incidence of reference ICUs (the top 10th percentile ranked ICU for the IAP incidence distribution), after adjustment (i.e. standardization) for patients and ICU characteristics. The PP of IAP was calculated as observed cases minus expected cases divided by observed cases. Results A total of 1840 intubated patients from 17 ICUs were enrolled. Overall, IAP incidence was 11.7 per 100 intubated patients and IAP rate was 11.8 per 1000 intubator-days. In the unadjusted model the PP of IAP was 0.82 (CI95%: 0.78-0.86); the PP was 0.47 (CI95%: 0.40-0.54) after standardization for case-mix. Conclusions Based on European surveillance data collected by the National ICU networks, more than 52% of ventilator-associated pneumonia could have been avoided (Lambert et al, 2014). Similarly, in the SPIN-UTI network, if IAP rates of ICUs with higher infection rates could have been reduced to that of the 10th percentile-ranked ICUs, then about 47% of IAPs could have been prevented by the implementation of preventive measures. Project realized with financial support by Ministry of Health – CCM.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
