Modifiable and non-modifiable risk factors for non-ventilator-associated hospital-acquired pneumonia (nvHAP) identified in a retrospective cohort study.

Kachalov, Viacheslav N; Kuster, Stefan P; Balakrishna, Suraj; Schreiber, Peter W; Jakob, Werner; Sax, Hugo; Kouyos, Roger D; Wolfensberger, Aline (2022). Modifiable and non-modifiable risk factors for non-ventilator-associated hospital-acquired pneumonia (nvHAP) identified in a retrospective cohort study. Clinical microbiology and infection, 28(11), pp. 1451-1457. Elsevier 10.1016/j.cmi.2022.05.011

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OBJECTIVES

Hospital-acquired pneumonia in non-ventilated patients (nvHAP) belongs to the most common healthcare-associated infections. This study aimed to investigate risk factors for nvHAP in patients outside the intensive care unit, focusing on modifiable risk factors.

METHODS

All inpatients admitted to an academic teaching hospital in Switzerland between 2017 and 2018 were included. NvHAP was defined according to European Centre for Disease Prevention and Control criteria. Patient days during and after ICU stay were excluded. Candidate risk factors - both constant and time-varying - were included in uni- and multivariable Cox proportional hazards models. The decay ratio and the characteristic time of influence of HRs was estimated by adopting a linear decay in the Cox model.

RESULTS

A total of 66,001 hospitalizations with 314 (0.48%) nvHAP and 471,401 patient days were included. Median age was 57 years (interquartile range: 38-71 years) and 32,253 (48.9%) patients were male. Among non-modifiable risk factors, age (adjusted-HR 2.66 for age ≥60 years, 95%CI 1.59-4.45) and male sex (aHR 1.71, 95%CI 1.34-2.18) were independently associated with nvHAP. Time-varying exposures showing strongest independent association with nvHAP were tube feeding (aHR 3.24, 95%CI 2.17-4.83), impaired consciousness (aHR 2.32, 95%CI 1.63-3.31), and severely impaired activity and mobility (aHR 2.06, 95%CI 1.50-2.84). The association with nvHAP decayed within 7.1 - 13.2 days after these exposures ended.

CONCLUSIONS

The risk for nvHAP varies with time, depending on the patient's medical condition and medical interventions. Several risk factors for nvHAP represent potential targets for specific prevention measures.

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