ventilator days [9], 15% [11], 15% [12] and 44.0 per 1,000 ventilator days at risk [10], although it seems relatively high. In our study a pneumonia was considered ventilator‐ associated when the infection day or the day before was a ventilator day. Many studies consider VAP when a patient is ventilated longer than 48 h [13]. This difference may account in part for a relatively high VAP rate. The CR‐BSI rate among patients with a central line was 3%. This figure is comparable to rates in other studies [14‐16]. Our CA‐ UTI rate of 8% was also in accordance with earlier reported CA‐UTI rates [17‐19]. Risk factors for infection The increased VAP, CR‐BSI and CA‐UTI risk as a consequence of device use (in general) and the effects of some of the other risk factors, for example, sex, were comparable to those reported previously [13;20;21]. After much debate [22‐24] a recent Cochrane review concluded that SDD, aimed at eradicating colonization of aerobic, potentially pathogenic micro‐organisms from the oropharynx, stomach, and gut, does benefit the ventilated patient [25]. In accordance with this, we found a decreased relative risk of acquiring VAP when receiving SDD. Although reported in several other studies the use of systemic antibiotics was not associated with VAP in this group. Ibrahim et al [12] found that multiple central venous line insertions increased the VAP risk, but in our data a central vascular catheter was not associated with a higher VAP risk. Also, in CVC patients, ventilation did not affect the risk of CR‐BSI, unlike the findings in another study [20]. An unexpected and unaccountable finding was acute admission lowering the risk of CR‐BSI. Impaired immunity increased the CA‐UTI risk whereas the use of systemic antibiotics at admission was associated with a lower risk. Ventilation or a central vascular catheter did not affect the CA‐UTI risk in our study. Duration of device use Our data showed that a longer time at risk increased the chance of infection. However, this association was less for VAP, when ventilation lasted longer than approx. 10 days, indicating that ventilation provokes pneumonia relatively early, rendering patients remaining ventilated without infection as ‘survivors’ with lower intrinsic risk for VAP [26]. The incidence density was highest in patients ventilated for 5‐9 days (Figure 1). Figure 2 shows that the proportion of patients developing VAP increased until day 5. Thereafter the percentage remained more or less constant until day 10 and declined slightly thereafter, although this was not statistically significant. An increase in VAP risk during the first 5 days or so, as we observed, has been reported by almost all studies [26‐28]. The results in patients ventilated for a longer period are less consistent. Unfortunately, the different ways of expressing the daily risk complicates comparisons between studies. 2 31 Device-associated infections and associated mortality in the ICU
RkJQdWJsaXNoZXIy MTk4NDMw