{"id":"https://openalex.org/W7225089451","doi":"https://doi.org/10.1186/s13756-026-01857-x","title":"Etiology and antimicrobial resistance profiles of ventilator-associated pneumonia in adult intensive care units in India: implications for infection prevention and antimicrobial stewardship - a systematic review and meta-analysis","display_name":"Etiology and antimicrobial resistance profiles of ventilator-associated pneumonia in adult intensive care units in India: implications for infection prevention and antimicrobial stewardship - a systematic review and meta-analysis","publication_year":2026,"publication_date":"2026-11-02","ids":{"openalex":"https://openalex.org/W7225089451","doi":"https://doi.org/10.1186/s13756-026-01857-x"},"language":"en","primary_location":{"id":"doi:10.1186/s13756-026-01857-x","doi":"https://doi.org/10.1186/s13756-026-01857-x","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13756-026-01857-x","pdf_url":null,"source":{"id":"https://openalex.org/S2737606590","display_name":"Antimicrobial Resistance and Infection Control","issn_l":"2047-2994","issn":["2047-2994"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Antimicrobial Resistance &amp; Infection Control","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1186/s13756-026-01857-x","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5160333906","display_name":"Jigish Shah","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I9694494","display_name":"Parul University","ror":"https://ror.org/024v3fg07","country_code":"IN","type":"education","lineage":["https://openalex.org/I9694494"]}],"countries":["IN"],"is_corresponding":true,"raw_author_name":"Jigish Shah","raw_affiliation_strings":["Department of Microbiology, Parul Institute of Medical Sciences & Research, Parul Sevashram Hospital, Clinical QualityParul University, Vadodara, Gujarat, India"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Microbiology, Parul Institute of Medical Sciences & Research, Parul Sevashram Hospital, Clinical QualityParul University, Vadodara, Gujarat, India","institution_ids":["https://openalex.org/I9694494"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5126456208","display_name":"Dhruv Hasmukhbhai Prajapati","orcid":"https://orcid.org/0009-0001-4936-9656","observed_orcids":["https://orcid.org/0009-0001-4936-9656","https://orcid.org/0009-0004-1525-4035"]},"institutions":[{"id":"https://openalex.org/I9694494","display_name":"Parul University","ror":"https://ror.org/024v3fg07","country_code":"IN","type":"education","lineage":["https://openalex.org/I9694494"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Dhruv Prajapati","raw_affiliation_strings":["Parul Institute of Medical Sciences and Research, Parul University, Vadodara, Gujarat, India"],"raw_orcid":"https://orcid.org/0009-0001-4936-9656","affiliations":[{"raw_affiliation_string":"Parul Institute of Medical Sciences and Research, Parul University, Vadodara, Gujarat, India","institution_ids":["https://openalex.org/I9694494"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5134486862","display_name":"Margeyi Mehta","orcid":"https://orcid.org/0009-0003-3326-1952","observed_orcids":["https://orcid.org/0009-0003-3326-1952"]},"institutions":[{"id":"https://openalex.org/I110116418","display_name":"Maharaja Sayajirao University of Baroda","ror":"https://ror.org/01bx8ja67","country_code":"IN","type":"education","lineage":["https://openalex.org/I110116418"]},{"id":"https://openalex.org/I259800356","display_name":"Sir Sayajirao General Hospital Medical College","ror":"https://ror.org/00j8xcs04","country_code":"IN","type":"education","lineage":["https://openalex.org/I259800356"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Margeyi Mehta","raw_affiliation_strings":["Department of Clinical Biochemistry, Medical College, Baroda, Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India"],"raw_orcid":"https://orcid.org/0009-0003-3326-1952","affiliations":[{"raw_affiliation_string":"Department of Clinical Biochemistry, Medical College, Baroda, Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India","institution_ids":["https://openalex.org/I110116418","https://openalex.org/I259800356"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5160333906"],"corresponding_institution_ids":["https://openalex.org/I9694494"],"apc_list":{"value":3290,"currency":"USD","value_usd":3290},"apc_paid":{"value":3290,"currency":"USD","value_usd":3290},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.87199528,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11681","display_name":"Nosocomial Infections in ICU","score":0.9970999956130981,"subfield":{"id":"https://openalex.org/subfields/2706","display_name":"Critical Care and Intensive Care Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11681","display_name":"Nosocomial Infections in ICU","score":0.9970999956130981,"subfield":{"id":"https://openalex.org/subfields/2706","display_name":"Critical Care and Intensive Care Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10147","display_name":"Antibiotic Resistance in Bacteria","score":0.002400000113993883,"subfield":{"id":"https://openalex.org/subfields/1313","display_name":"Molecular Medicine"},"field":{"id":"https://openalex.org/fields/13","display_name":"Biochemistry, Genetics and Molecular Biology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T10897","display_name":"Antibiotic Use and Resistance","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2402","display_name":"Applied Microbiology and Biotechnology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/ventilator-associated-pneumonia","display_name":"ventilator-associated pneumonia","score":0.9990000128746033},{"id":"https://openalex.org/keywords/antimicrobial-resistance","display_name":"antimicrobial resistance","score":0.9269999861717224},{"id":"https://openalex.org/keywords/intensive-care-unit","display_name":"intensive care unit","score":0.7699999809265137},{"id":"https://openalex.org/keywords/acinetobacter","display_name":"Acinetobacter","score":0.777999997138977},{"id":"https://openalex.org/keywords/klebsiella","display_name":"Klebsiella","score":0.9929999709129333},{"id":"https://openalex.org/keywords/pseudomonas","display_name":"Pseudomonas","score":0.9160000085830688},{"id":"https://openalex.org/keywords/multidrug-resistance","display_name":"multidrug resistance","score":0.7009999752044678},{"id":"https://openalex.org/keywords/gram-negative-bacteria","display_name":"Gram-negative bacteria","score":0.8199999928474426},{"id":"https://openalex.org/keywords/infection-control","display_name":"infection control","score":0.6499999761581421},{"id":"https://openalex.org/keywords/antimicrobial-stewardship","display_name":"antimicrobial stewardship","score":1.0},{"id":"https://openalex.org/keywords/india","display_name":"India","score":0.5149999856948853},{"id":"https://openalex.org/keywords/nosocomial-infections","display_name":"nosocomial infections","score":0.6299999952316284},{"id":"https://openalex.org/keywords/antimicrobial-susceptibility","display_name":"antimicrobial susceptibility","score":0.550000011920929},{"id":"https://openalex.org/keywords/hospital-acquired-pneumonia","display_name":"nosocomial pneumonia","score":0.503000020980835},{"id":"https://openalex.org/keywords/adults","display_name":"adults","score":0.328000009059906},{"id":"https://openalex.org/keywords/low-and-middle-income-countries","display_name":"low- and middle-income countries","score":0.7120000123977661}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.848800003528595},{"id":"https://openalex.org/C2776040555","wikidata":"https://www.wikidata.org/wiki/Q19903321","display_name":"Antimicrobial stewardship","level":4,"score":0.6240000128746033},{"id":"https://openalex.org/C2777914695","wikidata":"https://www.wikidata.org/wiki/Q12192","display_name":"Pneumonia","level":2,"score":0.5922999978065491},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.5659999847412109},{"id":"https://openalex.org/C94665300","wikidata":"https://www.wikidata.org/wiki/Q63391344","display_name":"Antibiotic resistance","level":3,"score":0.5613999962806702},{"id":"https://openalex.org/C2776933286","wikidata":"https://www.wikidata.org/wiki/Q132592","display_name":"Klebsiella pneumonia","level":4,"score":0.5605999827384949},{"id":"https://openalex.org/C2987404301","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care","level":2,"score":0.554099977016449},{"id":"https://openalex.org/C2778523567","wikidata":"https://www.wikidata.org/wiki/Q310457","display_name":"Acinetobacter","level":3,"score":0.5504000186920166},{"id":"https://openalex.org/C190139176","wikidata":"https://www.wikidata.org/wiki/Q598976","display_name":"Medical microbiology","level":2,"score":0.5253999829292297},{"id":"https://openalex.org/C189708586","wikidata":"https://www.wikidata.org/wiki/Q1504425","display_name":"Systematic review","level":3,"score":0.5148000121116638},{"id":"https://openalex.org/C2777184939","wikidata":"https://www.wikidata.org/wiki/Q7920253","display_name":"Ventilator-associated pneumonia","level":3,"score":0.5011000037193298},{"id":"https://openalex.org/C4937899","wikidata":"https://www.wikidata.org/wiki/Q68541106","display_name":"Antimicrobial","level":2,"score":0.4925999939441681},{"id":"https://openalex.org/C137627325","wikidata":"https://www.wikidata.org/wiki/Q156318","display_name":"Etiology","level":2,"score":0.47589999437332153},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.4758000075817108},{"id":"https://openalex.org/C114851261","wikidata":"https://www.wikidata.org/wiki/Q12147416","display_name":"Drug resistance","level":2,"score":0.4683000147342682},{"id":"https://openalex.org/C166888038","wikidata":"https://www.wikidata.org/wiki/Q4118322","display_name":"Infection control","level":2,"score":0.4449000060558319},{"id":"https://openalex.org/C95190672","wikidata":"https://www.wikidata.org/wiki/Q815382","display_name":"Meta-analysis","level":2,"score":0.41290000081062317},{"id":"https://openalex.org/C2779116282","wikidata":"https://www.wikidata.org/wiki/Q131854","display_name":"Klebsiella","level":4,"score":0.4016999900341034},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.37560001015663147},{"id":"https://openalex.org/C2777637488","wikidata":"https://www.wikidata.org/wiki/Q31856","display_name":"Pseudomonas aeruginosa","level":3,"score":0.3605000078678131},{"id":"https://openalex.org/C2776315533","wikidata":"https://www.wikidata.org/wiki/Q3241189","display_name":"Acinetobacter baumannii","level":4,"score":0.3521000146865845},{"id":"https://openalex.org/C107130276","wikidata":"https://www.wikidata.org/wiki/Q133805","display_name":"Epidemiology","level":2,"score":0.3450999855995178},{"id":"https://openalex.org/C83867959","wikidata":"https://www.wikidata.org/wiki/Q371467","display_name":"Scopus","level":3,"score":0.3257000148296356},{"id":"https://openalex.org/C152541439","wikidata":"https://www.wikidata.org/wiki/Q5186693","display_name":"Critical appraisal","level":3,"score":0.3107999861240387},{"id":"https://openalex.org/C501593827","wikidata":"https://www.wikidata.org/wiki/Q12187","display_name":"Antibiotics","level":2,"score":0.2937000095844269},{"id":"https://openalex.org/C133936738","wikidata":"https://www.wikidata.org/wiki/Q643839","display_name":"Multiple drug resistance","level":3,"score":0.27300000190734863},{"id":"https://openalex.org/C194828623","wikidata":"https://www.wikidata.org/wiki/Q2861470","display_name":"Emergency medicine","level":1,"score":0.2572000026702881}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1186/s13756-026-01857-x","doi":"https://doi.org/10.1186/s13756-026-01857-x","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13756-026-01857-x","pdf_url":null,"source":{"id":"https://openalex.org/S2737606590","display_name":"Antimicrobial Resistance and Infection Control","issn_l":"2047-2994","issn":["2047-2994"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Antimicrobial Resistance &amp; Infection Control","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1186/s13756-026-01857-x","doi":"https://doi.org/10.1186/s13756-026-01857-x","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s13756-026-01857-x","pdf_url":null,"source":{"id":"https://openalex.org/S2737606590","display_name":"Antimicrobial Resistance and Infection Control","issn_l":"2047-2994","issn":["2047-2994"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Antimicrobial Resistance &amp; Infection Control","raw_type":"journal-article"},"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[{"id":"https://openalex.org/study-designs/systematic-review","display_name":"Systematic Review"},{"id":"https://openalex.org/study-designs/meta-analysis","display_name":"Meta-Analysis"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W7214459070","https://openalex.org/W2905945145","https://openalex.org/W2515574400","https://openalex.org/W4386404782","https://openalex.org/W2575148395","https://openalex.org/W2854502321","https://openalex.org/W2993133917","https://openalex.org/W2992308156","https://openalex.org/W4225156787","https://openalex.org/W7053447081"],"abstract_inverted_index":{"Ventilator-associated":[0],"pneumonia":[1],"(VAP)":[2],"is":[3],"a":[4,116,125,144,221,308],"leading":[5,316],"healthcare-associated":[6],"infection":[7,46],"in":[8,84,88,210,264,292,323],"intensive":[9],"care":[10],"units":[11],"(ICUs)":[12],"and":[13,17,48,54,66,82,124,137,163,188,228,237,261,304,312,317,332,340,353],"disproportionately":[14],"affects":[15],"low-":[16],"middle-income":[18],"countries,":[19],"where":[20],"multidrug-resistant":[21],"Gram-negative":[22],"organisms":[23],"predominate.":[24],"No":[25],"systematic":[26,52],"review":[27,53],"has":[28],"pooled":[29,114,300],"the":[30,41,106,240,293,315],"extensive":[31],"single-centre":[32,338],"Indian":[33,85,324],"literature":[34],"to":[35,44,72,286],"provide":[36],"an":[37],"India-specific":[38],"synthesis":[39],"of":[40,68,101,277,321],"available":[42],"evidence":[43],"inform":[45],"prevention":[47],"antimicrobial":[49],"stewardship.":[50],"This":[51],"meta-analysis":[55],"followed":[56],"PRISMA":[57],"2020":[58,213],"(PROSPERO":[59],"CRD420261512214).":[60],"MEDLINE":[61],"(via":[62],"PubMed),":[63],"Embase,":[64],"Scopus":[65],"Web":[67],"Science":[69],"were":[70,113,149,200,231,302],"searched":[71],"15":[73],"September":[74],"2026":[75],"for":[76,172,181,191],"studies":[77,95,148,211,290,339],"(2016\u20132026)":[78],"reporting":[79],"VAP":[80,160,322],"etiology":[81],"susceptibility":[83],"ICUs,":[86,325],"predominantly":[87],"adults":[89],"(\u2265":[90],"18":[91],"years);":[92],"three":[93],"further":[94],"came":[96],"from":[97,212,284],"supplementary":[98],"sources.":[99],"Risk":[100],"bias":[102],"was":[103,141,167,208,255],"assessed":[104],"with":[105,115,130,143,326],"Joanna":[107],"Briggs":[108],"Institute":[109],"prevalence":[110,158,207],"checklist.":[111],"Proportions":[112],"binomial\u2013normal":[117],"generalised":[118],"linear":[119],"mixed":[120],"model":[121,128],"(GLMM;":[122],"primary)":[123],"Freeman\u2013Tukey":[126],"double-arcsine":[127],"(sensitivity),":[129],"prediction":[131,198],"intervals,":[132],"subgroup,":[133],"meta-regression,":[134],"leave-one-out,":[135,235],"trim-and-fill":[136],"age-restricted":[138,236],"analyses;":[139,239],"certainty":[140],"rated":[142],"GRADE-informed":[145],"approach.":[146],"Twenty-six":[147],"included;":[150],"22":[151],"(4,386":[152],"isolates)":[153],"contributed":[154],"isolate":[155],"counts.":[156],"Pooled":[157,335],"among":[159],"isolates":[161],"(genus-":[162],"species-level":[164],"reports":[165],"combined)":[166],"28.5%":[168],"(95%":[169],"CI":[170],"24.4\u201333.0)":[171],"Acinetobacter":[173,265,311],"(21":[174],"studies,":[175,184,194],"2,285":[176],"isolates;":[177,186,196],"I\u00b2=75%),":[178],"25.5%":[179],"(21.5\u201329.9)":[180],"Klebsiella":[182,204,206,241,313],"(22":[183,193],"4,386":[185,195],"I\u00b2=81%)":[187],"19.9%":[189],"(18.8\u201321.1)":[190],"Pseudomonas":[192],"I\u00b2=34%);":[197],"intervals":[199],"wide":[201],"(Acinetobacter":[202],"14.2\u201349.1%;":[203],"11.5\u201347.4%).":[205],"higher":[209],"onwards":[214],"(34.6%":[215],"vs.":[216],"21.7%;":[217],"p":[218,245],"=":[219,246],"0.001),":[220],"between-study":[222],"comparison":[223],"confounded":[224],"by":[225],"hospital":[226],"type":[227],"region.":[229],"Results":[230],"stable":[232],"across":[233,273,288],"model,":[234],"species-versus-genus":[238],"small-study":[242],"signal":[243],"(Egger":[244],"0.047)":[247],"depended":[248],"on":[249],"one":[250],"large":[251],"study.":[252],"Multidrug":[253],"resistance":[254,263,282],"74.4%":[256],"(58.4\u201385.7)":[257],"(6":[258],"studies;":[259,269],"I\u00b2=95%)":[260],"carbapenem":[262,333],"63.9%":[266],"(34.8\u201385.3)":[267],"(8":[268],"I\u00b2=96%;":[270],"range":[271],"52.6\u201378.8%":[272],"sensitivity":[274],"analyses),":[275],"both":[276],"very":[278],"low":[279],"certainty.":[280],"Colistin":[281],"ranged":[283],"0%":[285],"15.3%":[287],"four":[289],"(7.1%":[291],"largest":[294],"after":[295],"excluding":[296],"intrinsically":[297],"resistant":[298],"genera);":[299],"values":[301],"model-dependent":[303],"not":[305,342],"interpretable":[306],"as":[307],"national":[309,344],"rate.":[310],"are":[314,341],"near-equally":[318],"frequent":[319],"causes":[320],"high":[327],"but":[328],"highly":[329],"heterogeneous":[330],"multidrug":[331],"resistance.":[334],"figures":[336],"summarise":[337],"uniform":[343,359],"rates;":[345],"marked":[346],"between-hospital":[347],"variation":[348],"supports":[349],"unit-level":[350],"antibiogram":[351],"benchmarking":[352],"infection-prevention":[354],"bundle":[355],"compliance":[356],"rather":[357],"than":[358],"empirical":[360],"antibiotic":[361],"escalation.":[362]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-11-03T00:00:00"}
