Abstract
IntroductionPatients 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.MethodsOur 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.ResultsOverall, 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%).ConclusionsPatients 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.
Highlights
Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections
We identified the following significant independent risk factors for ventilator-associated pneumonia (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)
Units and investigators willing to participate sent data regarding the type of hospital, and data regarding the intensive care units (ICUs) used for postoperative care of MHS patients in each institution (ICU specific for MHS or mixed with other types of patients and number of beds available)
Summary
Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections. 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. Ventilator-associated pneumonia (VAP) is the most common infection in patients admitted to intensive care units (ICUs) [3,4] and is a leading cause of morbidity and mortality [5,6]. The situation of VAP in patients undergoing MHS has been assessed only from the perspective of single institutions with the bias of the case-mix at a particular centre [1,7,8,9,10]. Our study aims were to determine the incidence, aetiology, risk factors and outcome of VAP in a large sample of patients who have undergone MHS in Europe Our group led the collection of retrospective data of VAP in MHS from several European institutions [11], but prospective data from a large group of European centres were lacking.
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