Risk Factors for Ventilator-Associated Pneumonia in Patients Ventilated for Non-pulmonary Conditions: A Prospective Multicenter Cohort Study (PULMIVAP)

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ID: 332282
2026
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Abstract
Abstract Background Ventilator-associated pneumonia (VAP) is a frequent complication of invasive mechanical ventilation (IMV), yet its determinants in patients ventilated for non-pulmonary indications remain poorly characterized. Methods Data were derived from the PULMIVAP multicenter prospective cohort (ClinicalTrial:NCT04849039), conducted in eight Northern Italian intensive care units (January 2021-April 2024). All adults receiving IMV for non-pulmonary indications were enrolled if expected to require IMV >48 hours and antibiotic-free for ≥3 days preceding intubation. Clinical and therapeutic data were collected for up to 15 days of IMV; microbiological sampling was performed according to clinical indication. The primary outcome was time to first VAP within 15 days of IMV (VAP15). Associations between baseline characteristics, time-varying exposures, and VAP15 were evaluated. Thirty-day mortality from IMV initiation was a secondary outcome. Results Among 406 patients, 148 (36%) developed VAP15, at a median of 6 days (IQR 4.0-7.5) – an incidence rate of 43.2 per 1,000 ventilator-days at risk (95% CI,36.4-49.9). Non-neurologic diagnosis (adjusted hazard ratio [aHR] 0.51; 95% CI, 0.31-0.86), female sex (aHR, 0.52; 95% CI, 0.36-0.75) and early antibiotic initiation (days 1–2 of IMV, aHR, 0.65; 95% CI,0.45-0.93) were independently associated with lower risk of VAP15. Predominant pathogens were Staphylococcus aureus, Klebsiella spp., and Haemophilus influenzae; multidrug-resistant organisms were uncommon. VAP15 showed no competing relationship or significant association with mortality (overall, 20.4%). Conclusions In patients receiving IMV for non-pulmonary indications, non-neurologic diagnosis, female sex and early antibiotic exposure were associated with lower observed VAP incidence, though causality cannot be inferred. Risk-stratified prevention strategies warrant further investigation into this population.
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Authors Laura Alagna, Liliane Chatenoud, Emanuele Palomba, Ilaria Olgiati, Federico Magni, Leonardo Mancabelli, Francesca Turroni, Chiara Abbruzzese, Chiara Buracchi, Cristina Bugarin, Matteo Filippini, Andrea Forastieri Molinari, Giuseppe Gaipa, Roberto Fumagalli, Marina Munari, Antonio Muscatello, Edoardo Picetti, Leonardo Terranova, Rosanna Vaschetto, Tommaso Zoerle, Marco Ventura, Giuseppe Citerio, Andrea Gori, Alessandra Bandera, the PULMIVAP Study Group, Federica Sole Golfetto, Anna Tonizzo, Davide Mangioni, Francesca Elli, Silvia Del Bianco, Alessia Vargiolu, Christian Milani, Antonino Panacea, Nicola Latronico, Lorenzo Pilati, Gloria Erbici, Alberto Steffanoni, Martina Viganò, Cristina Panzeri, Daniele Cerani, Fabrizio Ortolano, Giacomo Grasselli, Sara Mazzarello, Chiara FIORENTINI, Gabriele Bassi, Riccardo Giudici, Elisabetta Zago, Francesca Grossi, Nello De Vita, Stefania Guido, Eduardo Rocca, Federico Geraldini, Alessandro De Cassai, Marzia Grandis, Sabrina Calandra, Marco Di Lecce, Bianca Maria Mainini, Emanuele Sani
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag677
URL
https://doi.org/10.1093/ofid/ofag677
Keywords Keywords not found

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