%0 Journal Article
%T Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study
%A Philippe Vanhems
%A Thomas B¨¦net
%A Nicolas Voirin
%A Jean-Marie Januel
%A Alain Lepape
%A Bernard Allaouchiche
%A Laurent Argaud
%A Dominique Chassard
%A Claude Gu¨¦rin
%A the Study Group
%J BMC Infectious Diseases
%D 2011
%I BioMed Central
%R 10.1186/1471-2334-11-236
%X We analyzed data from prospective surveillance between 01/01/2001 and 31/12/2009 in 11 ICUs of Lyon hospitals (France). The inclusion criteria were: first ICU admission, not hospitalized before admission, invasive mechanical ventilation during first ICU day, free of antibiotics at admission, and ICU stay ¡Ý 48 hours. VAP was defined according to a national protocol. Its incidence was the number of events per 1,000 invasive mechanical ventilation-days. The Poisson regression model was fitted from day 2 (D2) to D8 to incident VAP to estimate the expected VAP incidence from D0 to D1 of ICU stay.Totally, 367 (10.8%) of 3,387 patients in 45,760 patient-days developed VAP within the first 9 days. The predicted cumulative VAP incidence at D0 and D1 was 5.3 (2.6-9.8) and 8.3 (6.1-11.1), respectively. The predicted cumulative VAP incidence was 23.0 (20.8-25.3) at D8. The proportion of missed VAP within 48 hours from admission was 11% (9%-17%).Our study indicates underestimation of early-onset VAP incidence in ICUs, if only VAP occurring ¡Ý 48 hours are considered to be hospital-acquired. Clinicians should be encouraged to develop a strategy for early detection after ICU admission.The epidemiological surveillance of healthcare-associated infections (HAIs) in intensive care units (ICUs) provides clinicians and caregivers with trend descriptions and contributes to HAI prevention [1-4]. When studies from such epidemiological surveillance programs are carried out, standardized definitions of risk factors for HAI must be used. However, these distinctions as well as the terminology adopted change over time. Indeed, in the last Centers for Disease Control and Prevention definition, HAI replaced the term "hospital-acquired infection" [5].To exclude community-acquired infections, it was acknowledged that a period of 48 hours between ICU admission and the onset of symptoms was required to identify cases as hospital-acquired infections [1-4,6-10]. The time window of 48 hours was first con
%U http://www.biomedcentral.com/1471-2334/11/236