Ventilator-associated Pneumonia in Males and Females: A Post Hoc Analysis of the Prospective Multicenter Multinational EUVAP Cohort

Background Sex is a major cause of heterogeneity in the epidemiology, management, response to treatment, and outcome of infectious and respiratory diseases. We aimed to describe differences between males and females in characteristics, management, and mortality among patients affected by ventilator-associated pneumonia (VAP). Methods We performed a post hoc exploratory analysis of the EUVAP/CAP cohort, a prospective multinational cohort study of patients requiring mechanical ventilation in 27 intensive care units from nine countries. Sexes were compared with respect to baseline characteristics, interventions, and outcomes in univariate and adjusted analyses. Results Among the 2436 intubated adult patients in the cohort, 450 (18.5%) developed VAP; of these VAP cases, 293 (65.1%) were male, and the median age was 64 years. Compared with females, males had more comorbidities, and underwent bronchoscopy more frequently (20.5% vs. 11.5%, P=0.016) and triple antibiotic therapy (33.1% vs. 22.3%, P=0.016)., Intensive care unit mortality was 41.3% vs. 45.2% (P=0.422). In multivariate analysis, age in years (adjusted odds ratio [aOR]=1.02, 95%confidence interval [CI]: 1.00 to 1.04), septic shock (aOR=1.72, 95%CI: 1.02 to 2.91), McCabe score (life expectancy 1–5 years vs. >5 years: aOR=1.53, 95%CI: 0.81 to 2.54; 〈1 year vs. 〉 5 years: aOR=7.67, 95%CI: 2.41 to 24.39; P=0.002), and infection with high risk bacteria for multidrug resistance (aOR=1.86, 95%CI: 1.12 to 3.09; P=0.016) were independently associated with mortality, but not sex (aOR for males vs. females=0.92, 95%CI 0.56 to 1.49; P=0.722). The relation between sex and mortality was not affected by age <50 years. Conclusions The risk of mortality did not differ between sexes in patients affected by VAP. Affected males had more comorbidities, heavy alcohol use, and underwent bronchoscopy and triple antibiotic therapy more frequently.