Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe
| Autor: | Hortal, Javier, Munoz, Patricia, Cuerpo, Gregorio, Litvan, Hector, Rosseel, Peter M., Bouza, Emilio, European Study Grp Nosocomial Infe, European Workgrp Cardiothoracic In |
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| Jazyk: | angličtina |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment humanos Critical Care and Intensive Care Medicine incidencia law.invention Risk Factors law estudios prospectivos medicine factores de riesgo Humans análisis multifactorial Prospective Studies Cardiac Surgical Procedures Antibiotic prophylaxis procedimientos quirúrgicos cardíacos Prospective cohort study mediana edad Mechanical ventilation business.industry resultado del tratamiento Incidence Research Incidence (epidemiology) profilaxis antibiótica Ventilator-associated pneumonia Pneumonia Ventilator-Associated neumonía Pneumonia Odds ratio Antibiotic Prophylaxis Middle Aged medicine.disease Intensive care unit Surgery Europe Treatment Outcome Multivariate Analysis Female business |
| Zdroj: | Critical Care CRITICAL CARE r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| ISSN: | 1364-8535 1466-609X |
| DOI: | 10.1186/cc7896 |
| Popis: | Introduction Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections. Postoperative infection is the main non-cardiac complication after MHS and has been clearly related to increased morbidity, use of hospital resources and mortality. Our aim was to determine the incidence, aetiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients who have undergone MHS in Europe. Methods Our study was a prospective study of patients undergoing MHS in Europe who developed suspicion of VAP. During a one-month period, participating units submitted a protocol of all patients admitted to their units who had undergone MHS. Results Overall, 25 hospitals in eight different European countries participated in the study. The number of patients intervened for MHS was 986. Fifteen patients were excluded because of protocol violations. One or more nosocomial infections were detected in 43 (4.4%) patients. VAP was the most frequent nosocomial infection (2.1%; 13.9 episodes per 1000 days of mechanical ventilation). The microorganisms responsible for VAP in this study were: Enterobacteriaceae (45%), Pseudomonas aeruginosa (20%), methicillin-resistant Staphylococcus aureus (10%) and a range of other microorganisms. We identified the following significant independent risk factors for VAP: ascending aorta surgery (odds ratio (OR) = 6.22; 95% confidence interval (CI) = 1.69 to 22.89), number of blood units transfused (OR = 1.08 per unit transfused; 95% CI = 1.04 to 1.13) and need for re-intervention (OR = 6.65; 95% CI = 2.10 to 21.01). The median length of stay in the intensive care unit was significantly longer (P < 0.001) in patients with VAP than in patients without VAP (23 days versus 2 days). Death was significantly more frequent (P < 0.001) in patients with VAP (35% versus 2.3%). Conclusions Patients undergoing aortic surgery and those with complicated post-intervention courses, requiring multiple transfusions or re-intervention, constitute a high-risk group probably requiring more active preventive measures. The study was supported in part by Ciber de Enfermedades Respiratorias (CIBERES) and by the Rafael del Pino Foundation. We thank Lawrence JC Baron for his review of the English version of the manuscript and Cristina Fernandez for her contribution to the statistical analysis. We thank Dr M Desco and Dr J Pascau of the Medical Image Laboratory of Experimental Medicine for their support with the electronic retrieval of the data. |
| Databáze: | OpenAIRE |
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