Effect of preoperative pneumococcal immunization on the incidence of respiratory infection in the postoperative period of cardiac surgery

Stéfani Galli,Ana Carolina Mello Fontoura De Souza,Dionizia Xavier Scomparin,Mário Augusto Cray Da Costa

doi:10.33448/rsd-v10i4.13982

Stéfani Galli, Ana Carolina Mello Fontoura De Souza + Show 2 more

Open Access

https://doi.org/10.33448/rsd-v10i4.13982

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Abstract

Objective: To analyze whether the incidence of respiratory infections in the postoperative period of cardiac surgery is lower in patients immunized with the 13-valent pneumococcal conjugate vaccine. To study the main risk factors related to the development of infections in patients undergoing cardiac surgery. Methodology: 40 patients were included in the study, randomized 1: 1 to receive pneumococcal vaccine or placebo, 14 days before undergoing elective cardiac surgery. The incidence of infections in the 30 postoperative days was compared between groups. Results: There were 6 respiratory infections in the vaccine group and 2 in the placebo group (p=0.2024) and one death in the placebo group and none in the vaccine group (p=0.3173). Chronic obstructive pulmonary disease (p=0.003), diabetes mellitus (p=0.047) and peripheral arterial disease (p=0.0001) were listed as risk factors for the development of infections, which generated an increase in hospital stay (95% CI : 1.33- 7.13; p =0.0147) and ICU stay in the postoperative period (95% CI: 1.87- 33.45; p=0.0025). Conclusion: The application of pneumococcal vaccine 13v did not influence the development of postoperative pulmonary infections. Chronic obstructive pulmonary disease, diabetes mellitus and peripheral arterial disease were identified as risk factors for the development of infections, increasing the length of total hospital stay and time in the ICU.

Highlights

Cardiovascular diseases (CVD) are the main causes of death in the world, with the greatest impact in low and middle income countries, according to Lentsck, Latorre and Mathias (2015)
This study aimed to study whether the application of this vaccine 14 days before elective cardiac surgery would decrease the incidence of postoperative infections, including pneumonia
2.2 Inclusion and Exclusion Criteria The inclusion criteria were: male and female patients candidates for elective cardiac surgery, who signed the Free and Informed Consent Form (ICF), older than 50 years, who were not immunized with any dose of pneumococcal conjugate vaccine during their lifetime

Summary

Introduction

Cardiovascular diseases (CVD) are the main causes of death in the world, with the greatest impact in low and middle income countries, according to Lentsck, Latorre and Mathias (2015). In Brazil, in 2016, these diseases were the cause of death for more than 360 thousand people, predominantly male, white and over 65 years old (Ministry of Health , 2019). The treatment of such diseases is done through surgical interventions, very common in Brazil, where approximately 102 thousand operations are performed annually (Dordetto; Pinto Rosa, 2016). There are various pneumococcal vaccines available, among them the pneumococcal conjugate vaccine 13valent, which prevents about 90% of the diseases caused by 13 different serotypes of pneumococci (SBIM, 2020) Among the main etiologic agents of pneumonia, whether hospitalized or acquired in the community, is Streptococcus pneumoniae, a lanceolate diplococcus, which causes pneumonias, and meningitis, septic arthritis, pleurisy and endocarditis (Bonten et al, 2015).

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