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Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe

Javier Hortal1*, Patricia Muñoz2,6, Gregorio Cuerpo3, Hector Litvan4, Peter M Rosseel5, Emilio Bouza2,6, the European Study Group on Nosocomial Infections and the European Workgroup of Cardiothoracic Intensivists

Author Affiliations

1 Anaesthesia Department. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo 46 – 28007 Madrid, Spain

2 Clinical Microbiology and Infectious Diseases Department. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo 46 – 28007 Madrid, Spain

3 Cardiac Surgery Department. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo 46 – 28007 Madrid, Spain

4 Anaesthesia Department. Hospital Sant Creu i Sant Pau. Sant Antoni Maria Claret, 167 – 08025 Barcelona, Spain

5 Anaesthesia and Critical Care Department. Thoraxcenter Amphia. Galderseweg 81 – 4836AE Breda, Holland

6 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Fundación Caubet-Cimera, Recinto Hospital Joan March, Carretera Soller Km 12, 07110, Bunyola, Mallorca, Spain

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Critical Care 2009, 13:R80 doi:10.1186/cc7896

Published: 22 May 2009

Abstract

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.