Original

Intensive Care Medicine

, Volume 35, Issue 9, pp 1518-1525

Incidence and risk factors for ventilator-associated pneumonia after major heart surgery

  • Javier HortalAffiliated withDepartment of Anesthesia, Hospital General Universitario Gregorio Marañón
  • , Maddalena GiannellaAffiliated withDepartment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
  • , Maria Jesús PérezAffiliated withDepartment of Anesthesia, Hospital General Universitario Gregorio Marañón
  • , José Maria BarrioAffiliated withDepartment of Anesthesia, Hospital General Universitario Gregorio Marañón
  • , Manuel DescoAffiliated withDepartment of Experimental Medicine, Hospital General Universitario Gregorio Marañón
  • , Emilio BouzaAffiliated withDepartment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio MarañónCIBER de Enfermedades Respiratorias (CIBERES)
  • , Patricia MuñozAffiliated withDepartment of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio MarañónCIBER de Enfermedades Respiratorias (CIBERES) Email author 

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Abstract

Purpose

Major heart surgery (MHS) patients are a particularly high-risk population for nosocomial infections. Our objective was to identify risk factors for ventilator-associated pneumonia (VAP) in patients undergoing MHS.

Methods

Prospective study including 1,844 patients operated from 2003 to 2006.

Results

Overall 106 patients (140 episodes) developed one or more episodes of VAP (5.7%, 22.2 episodes per 1,000 days of mechanical ventilation). VAP incidence was 45.9% in those patients requiring more than 48 h of MV. Enterobacteriaceae (32.8), Pseudomonas aeruginosa (28.6%) and Staphylococcus aureus (27.1%, of which 65.8% were methicillin resistant) were the principal microorganisms causing VAP. The independent risk factors for VAP were: age >70, perioperative transfusions, days of mechanical ventilation, reintubation, previous cardiac surgery, emergent surgery and intraoperative inotropic support. Median length of stay in the ICU for patients who developed VAP or not was, respectively, 25.5 versus 3 days (P < 0.001), and mortality was, respectively, 45.7 versus 2.8% in both populations (P < 0.001). We developed a predictive preoperative score with a sensitivity of 93% and a specificity of 40%.

Conclusions

VAP is common in patients undergoing MHS that require more than 48 h of MV. In that “high-risk” population, innovative preventive measures should be developed and applied.

Keywords

Ventilator-associated pneumonia Heart surgery Nosocomial infection Nosocomial pneumonia Risk factors for ICU nosocomial infection