disease burden of intensive care unit-acquired pneumonia in china: a systematic review and meta-analysis

Background: Intensive care unit (ICU)-acquired pneumonia and ventilator-associated pneumonia (VAP) are associated with poor clinical and economic outcomes. Data regarding ICU-acquired pneumonia and VAP are not readily available from developing countries, including China. The objective of this meta-analysis was to evaluate the incidence, mortality rate, length of stay, and pathogens associated with ICU-acquired pneumonia in China. Methods: A meta-analysis and systematic review of 334 publications published between January 2007 and May 2012 and retrieved from the Chinese BioMedical database, China National Knowledge Infrastructure, VIP Chinese Science and Technique Journals database, Wanfang database, and PubMed was conducted. Results: The incidences of ICU-acquired pneumonia and VAP were 16.2% (95% confidence interval (CI) 12.8–20.4%) and 33.7% (95% CI 31.4–36.1%), respectively; mortality rates were 37.4% (95% CI 24.6–52.2%) and 34.5% (95% CI 29.2–40.1%), respectively. The durations of stay in the ICU and hospital were 12.4 (95% CI 9.6–15.3) and 17.7 (95% CI 15.6–19.7) days and 18.0 (95% CI 16.5–19.6) and 30.5 (95% CI 26.4–34.7) days for ICU-acquired pneumonia and VAP, respectively. Pseudomonas aeruginosa (19.9%) and Acinetobacter baumannii (13.9%) were the most frequently isolated pathogens, followed by Klebsiella pneumoniae (11.9%) and Staphylococcus aureus (10.4%); 82.9% of S. aureus isolates were reported to be methicillin-resistant. Conclusions: ICU-acquired pneumonia/VAP remains a major cause of morbidity and mortality in patients in the ICU in China. Data on organisms causing disease in this population could help guide appropriate prevention strategies and treatment.