Critical Care Volume 13 Issue 3 |
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 ResearchVentilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in EuropeJavier Hortal1 , Patricia Muñoz2,6 , Gregorio Cuerpo3 , Hector Litvan4 , Peter M Rosseel5 and Emilio Bouza2,6 for the European Study Group on Nosocomial Infections for the European Workgroup of Cardiothoracic Intensivists 1Anaesthesia Department. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo 46 – 28007 Madrid, Spain 2Clinical Microbiology and Infectious Diseases Department. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo 46 – 28007 Madrid, Spain 3Cardiac Surgery Department. Hospital General Universitario Gregorio Marañón. Dr. Esquerdo 46 – 28007 Madrid, Spain 4Anaesthesia Department. Hospital Sant Creu i Sant Pau. Sant Antoni Maria Claret, 167 – 08025 Barcelona, Spain 5Anaesthesia and Critical Care Department. Thoraxcenter Amphia. Galderseweg 81 – 4836AE Breda, Holland 6Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Fundación Caubet-Cimera, Recinto Hospital Joan March, Carretera Soller Km 12, 07110, Bunyola, Mallorca, Spain author email corresponding author email
Critical Care 2009,
13:R80doi:10.1186/cc7896 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. |