PREVALENCE AND RISK FACTORS OF VENTILATOR–ASSOCIATED PNEUMONIA IN ICU SETTINGS: A NARRATIVE REVIEW

Abstract

Ventilator-associated pneumonia (VAP), a major hospital-acquired infection, affects 5% to 40% of patients on mechanical ventilators worldwide, with rates varying by region, ICU type, and diagnostic criteria. Its mortality rate can range from 10% to over 30%, particularly in cases involving multidrug-resistant organisms (MRO). VAP increases ICU stays and duration of mechanical ventilation (MV), driving up healthcare costs. This review aims to synthesize recent evidence on the prevalence of VAP in ICUs and reported risk factors across different settings. Articles published between January 2020 and June 2025 that included adult ICU patients were selected. The literature search was conducted following SANRA guidelines and using databases including PubMed, Scopus, Google Scholar with key words such as ‘ventilator-associated pneumonia,’ ‘prevalence,’ ‘risk factors,’ ‘ICU,’ and ‘mechanical ventilation’. Only peer-reviewed original research was included. Systematic and narrative reviews were considered only to provide contextual background but were not included as primary evidence. Results were presented in tables highlighting the author and year, title of the study, study design, and key findings of each study. Prevalence of VAP ranged from 9% to 50% depending on region, patient condition, and ICU protocols. Multicenter studies indicate a prevalence of 20-35%. Patients with traumatic brain injuries (TBI) and those with COVID-19 indicated VAP prevalence rates exceeding 45%. Risk factors included prolonged MV, reintubation, TBI, use of sedatives, biofilm formation on endotracheal tubes, and infection by MRO. COVID-19 ICU patients were found to have higher rates of VAP, often involving MRO. VAP is still a considerable healthcare concern in ICU settings, with prevalence and risk factors strongly influenced by patients’ clinical conditions, regional healthcare practices, and individual patient characteristics. This review highlights the need for risk-specific prevention strategies, particularly in high-risk populations. Continued surveillance, adherence to evidence-based protocols, and antimicrobial stewardship are critical to reducing VAP occurrence and improving patient outcomes.