Risk Factors for Ventilator-Associated Pneumonia in Patients Ventilated for Non-Pulmonary Conditions: A Prospective Multicenter Cohort Study (PULMIVAP)
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 8 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) with an incidence rate of 43.2 per 1000 ventilator-days at risk (95% confidence intervals [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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BibTeX
@article{alagna2026risk,
title = {{Risk Factors for Ventilator-Associated Pneumonia in Patients Ventilated for Non-Pulmonary Conditions: A Prospective Multicenter Cohort Study (PULMIVAP)}},
author = {Laura Alagna and Liliane Chatenoud and Emanuele Palomba and Ilaria Olgiati and Federico Magni and Leonardo Mancabelli and Francesca Turroni and Chiara Abbruzzese and Chiara Buracchi and Cristina Bugarin and Matteo Filippini and Andrea Forastieri and Giuseppe Gaipa and Roberto Fumagalli and Marina Munari and Antonio Muscatello and Edoardo Picetti and Leonardo Terranova and Rosanna Vaschetto and Tommaso Zoerle and Marco Ventura and Giuseppe Citerio and Andrea Gori and Alessandra Bandera and Federica Sole Golfetto and Federica Sole Golfetto and Anna Tonizzo and Davide Mangioni and Francesca Elli and Silvia Del Bianco and Alessia Vargiolu and Christian Milani and Antonino Panacea and Nicola Latronico and Lorenzo Pilati and Gloria Erbici and Alberto Steffanoni and Martina Viganò and Cristina Panzeri and Daniele Cerani and Fabrizio Ortolano and Giacomo Grasselli and Sara Mazzarello and Chiara Fiorentini and Gabriele Bassi and Riccardo Giudici and Elisabetta Zago and Francesca Grossi and Nello De Vita and Stefania Guido and Eduardo Rocca and Federico Geraldini and Alessandro De Cassai and Marzia Grandis and Sabrina Calandra and Marco di Lecce and Bianca Maria Mainini and Emanuele Sani},
journal = {Open Forum Infectious Diseases},
year = {2026},
month = oct,
doi = {10.1093/ofid/ofag677},
url = {https://doi.org/10.1093/ofid/ofag677},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Risk Factors for Ventilator-Associated Pneumonia in Patients Ventilated for Non-Pulmonary Conditions: A Prospective Multicenter Cohort Study (PULMIVAP)
AU - Laura Alagna
AU - Liliane Chatenoud
AU - Emanuele Palomba
AU - Ilaria Olgiati
AU - Federico Magni
AU - Leonardo Mancabelli
AU - Francesca Turroni
AU - Chiara Abbruzzese
AU - Chiara Buracchi
AU - Cristina Bugarin
AU - Matteo Filippini
AU - Andrea Forastieri
AU - Giuseppe Gaipa
AU - Roberto Fumagalli
AU - Marina Munari
AU - Antonio Muscatello
AU - Edoardo Picetti
AU - Leonardo Terranova
AU - Rosanna Vaschetto
AU - Tommaso Zoerle
AU - Marco Ventura
AU - Giuseppe Citerio
AU - Andrea Gori
AU - Alessandra Bandera
AU - Federica Sole Golfetto
AU - Federica Sole Golfetto
AU - Anna Tonizzo
AU - Davide Mangioni
AU - Francesca Elli
AU - Silvia Del Bianco
AU - Alessia Vargiolu
AU - Christian Milani
AU - Antonino Panacea
AU - Nicola Latronico
AU - Lorenzo Pilati
AU - Gloria Erbici
AU - Alberto Steffanoni
AU - Martina Viganò
AU - Cristina Panzeri
AU - Daniele Cerani
AU - Fabrizio Ortolano
AU - Giacomo Grasselli
AU - Sara Mazzarello
AU - Chiara Fiorentini
AU - Gabriele Bassi
AU - Riccardo Giudici
AU - Elisabetta Zago
AU - Francesca Grossi
AU - Nello De Vita
AU - Stefania Guido
AU - Eduardo Rocca
AU - Federico Geraldini
AU - Alessandro De Cassai
AU - Marzia Grandis
AU - Sabrina Calandra
AU - Marco di Lecce
AU - Bianca Maria Mainini
AU - Emanuele Sani
PY - 2026
DA - 2026/10/13
JO - Open Forum Infectious Diseases
DO - 10.1093/ofid/ofag677
UR - https://doi.org/10.1093/ofid/ofag677
AB - 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 8 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) with an incidence rate of 43.2 per 1000 ventilator-days at risk (95% confidence intervals [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.
SN - 2328-8957
ER -