Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 3/2009

Open Access 01-06-2009 | Research

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

Authors: Javier Hortal, Patricia Muñoz, Gregorio Cuerpo, Hector Litvan, Peter M Rosseel, Emilio Bouza, the European Study Group on Nosocomial Infections, the European Workgroup of Cardiothoracic Intensivists

Published in: Critical Care | Issue 3/2009

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Kollef MH, Sharpless L, Vlasnik J, Pasque C, Murphy D, Fraser VJ: The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest. 1997, 112: 666-675. 10.1378/chest.112.3.666.CrossRefPubMed
2.
Welsby IJ, Bennett-Guerrero E, Atwell D, White WD, Newman MF, Smith PK, Mythen MG: The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg. 2002, 94: 1072-1078. 10.1097/00000539-200205000-00004.CrossRefPubMed
3.
Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef MH: Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002, 122: 2115-2121. 10.1378/chest.122.6.2115.CrossRefPubMed
4.
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M: The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995, 274: 639-644. 10.1001/jama.274.8.639.CrossRefPubMed
5.
George DL: Epidemiology of nosocomial pneumonia in intensive care unit patients. Clin Chest Med. 1995, 16: 29-44.PubMed
6.
Richards MJ, Edwards JR, Culver DH, Gaynes RP: Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med. 1999, 27: 887-892. 10.1097/00003246-199905000-00020.CrossRefPubMed
7.
Bouza E, Perez A, Munoz P, Jesus Perez M, Rincon C, Sanchez C, Martin-Rabadan P, Riesgo M: Ventilator-associated pneumonia after heart surgery: A prospective analysis and the value of surveillance. Crit Care Med. 2003, 31: 1964-1970. 10.1097/01.ccm.0000084807.15352.93.CrossRefPubMed
8.
Leal-Noval SR, Marquez-Vacaro JA, Garcia-Curiel A, Camacho-Larana P, Rincon-Ferrari MD, Ordonez-Fernandez A, Flores-Cordero JM, Loscertales-Abril J: Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med. 2000, 28: 935-940. 10.1097/00003246-200004000-00004.CrossRefPubMed
9.
Pawar M, Mehta Y, Khurana P, Chaudhary A, Kulkarni V, Trehan N: Ventilator-associated pneumonia: incidence, risk factors, outcome, and microbiology. J Cardiothorac Vasc Anesth. 2003, 17: 22-28. 10.1053/jcan.2003.4.CrossRefPubMed
10.
Simsek S, Yurtseven N, Gercekogalu H, Izgi F, Sohtorik U, Canik S, Ozler A: Ventilator-associated pneumonias in a cardiothoracic surgery centre postoperative intensive care unit. J Hosp Infect. 2001, 47: 321-324. 10.1053/jhin.2000.0932.CrossRefPubMed
11.
Bouza E, Hortal J, Munoz P, Perez MJ, Riesgo MJ, Hiesmayr M: Infections following major heart surgery in European intensive care units: there is room for improvement (ESGNI 007 Study). J Hosp Infect. 2006, 63: 399-405. 10.1016/j.jhin.2006.03.007.CrossRefPubMed
12.
McCabe W, Jackson G: Gram-negative bacteremia, I: etiology and ecology. Arch Inter Med. 1962, 110: 847-855.CrossRef
13.
Charlson M, Pompei P, Ales K, MacKenzie C: A new method of classifiying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40: 373-383. 10.1016/0021-9681(87)90171-8.CrossRefPubMed
14.
American Society of Anesthesiologists: New classification of physical status. Anesthesiology. 1963, 24: 111-
15.
Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salomon R: European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999, 16: 9-13. 10.1016/S1010-7940(99)00134-7.CrossRefPubMed
16.
Pugin J, Auckenthaler R, Mili N, Janssens JP, Lew PD, Suter PM: Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic "blind" bronchoalveolar lavage fluid. Am Rev Respir Dis. 1991, 143: 1121-1129.CrossRefPubMed
17.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM: CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988, 16: 128-140. 10.1016/0196-6553(88)90053-3.CrossRefPubMed
18.
Ang RP: Use of the Jacknife statistic to evaluate result replicability. J Gen Psychol. 1998, 125: 218-228.CrossRef
19.
Girou E, Stephan F, Novara A, Safar M, Fagon JY: Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med. 1998, 157: 1151-1158.CrossRefPubMed
20.
Legras A, Malvy D, Quinioux AI, Villers D, Bouachour G, Robert R, Thomas R: Nosocomial infections: prospective survey of incidence in five French intensive care units. Intensive Care Med. 1998, 24: 1040-1046. 10.1007/s001340050713.CrossRefPubMed
21.
Rebollo MH, Bernal JM, Llorca J, Rabasa JM, Revuelta JM: Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg. 1996, 112: 908-913. 10.1016/S0022-5223(96)70090-9.CrossRefPubMed
22.
Bouza E, Hortal J, Munoz P, Pascau J, Perez MJ, Hiesmayr M: Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study (ESGNI-008). J Hosp Infect. 2006, 64: 224-230. 10.1016/j.jhin.2006.06.019.CrossRefPubMed
23.
Zickman B, Sablotzki A, Fussle R, Gorlach G, Hempelmann G: Perioperative microbiologic monitoring of tracheal aspirates as a predictor of pulmonary complications after cardiac operations. J Thorac Cardiovasc Surg. 1996, 111: 1213-1218. 10.1016/S0022-5223(96)70224-6.CrossRefPubMed
24.
Gaynes R, Bizek B, Mowry-Hanley J, Kirsh M: Risk factors for nosocomial pneumonia after coronary artery bypass graft operations. Ann Thorac Surg. 1991, 51: 215-218.CrossRefPubMed
25.
Carrel T, Schmid ER, von Segesser L, Vogt M, Turina M: Preoperative assessment of the likelihood of infection of the lower respiratory tract after cardiac surgery. Thorac Cardiovasc Surg. 1991, 39: 85-88. 10.1055/s-2007-1013938.CrossRefPubMed
26.
National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004, 32: 470-485. 10.1016/j.ajic.2004.10.001.
27.
Chastre J, Fagon JY: Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002, 165: 867-903.CrossRefPubMed
28.
Bryan CS, Reynolds KL: Bacteremic nosocomial pneumonia. Analysis of 172 episodes from a single metropolitan area. Am Rev Respir Dis. 1984, 129: 668-671.CrossRefPubMed
29.
Chastre J, Trouillet JL, Vuagnat A, Joly-Guillou ML, Clavier H, Dombret MC, Gibert C: Nosocomial pneumonia in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 1998, 157: 1165-1172.CrossRefPubMed
30.
Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, Gibert C: Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis. 1989, 139: 877-884.CrossRefPubMed
31.
Kollef MH: Ventilator-associated pneumonia. A multivariate analysis. JAMA. 1993, 270: 1965-1970. 10.1001/jama.270.16.1965.CrossRefPubMed
32.
Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL: Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000, 162: 505-511.CrossRefPubMed
33.
Sanchez Garcia M, Cambronero Galache JA, Lopez Diaz J, Cerda Cerda E, Rubio Blasco J, Gomez Aguinaga MA, Nunez Reiz A, Rogero Marin S, Onoro Canaveral JJ, Sacristan del Castillo JA: Effectiveness and cost of selective decontamination of the digestive tract in critically ill intubated patients. A randomized, double-blind, placebo-controlled, multicenter trial. Am J Respir Crit Care Med. 1998, 158: 908-916.CrossRefPubMed
34.
van Saene HK, Petros AJ, Ramsay G, Baxby D: All great truths are iconoclastic: selective decontamination of the digestive tract moves from heresy to level 1 truth. Intensive Care Med. 2003, 29: 677-690. 10.1007/s00134-003-1770-7.CrossRefPubMed
35.
Bouza E, Perez MJ, Munoz P, Rincon C, Barrio JM, Hortal J: Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest. 2008, 134: 938-946. 10.1378/chest.08-0103.CrossRefPubMed
36.
Poelaert J, Depuydt P, De Wolf A, Velde Van de S, Herck I, Blot S: Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study. J Thorac Cardiovasc Surg. 2008, 135: 771-776. 10.1016/j.jtcvs.2007.08.052.CrossRefPubMed
Metadata
Title
Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe
Authors
Javier Hortal
Patricia Muñoz
Gregorio Cuerpo
Hector Litvan
Peter M Rosseel
Emilio Bouza
the European Study Group on Nosocomial Infections
the European Workgroup of Cardiothoracic Intensivists
Publication date
01-06-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc7896

Other articles of this Issue 3/2009

Critical Care 3/2009 Go to the issue

Research

Results from the national sepsis practice survey: predictions about mortality and morbidity and recommendations for limitation of care orders

Commentary

Antimicrobial catheters in the ICU: is the juice worth the squeeze?

Research

Low-dose vasopressin infusion results in increased mortality and cardiac dysfunction following ischemia-reperfusion injury in mice

Research

Cytomegalovirus infection in critically ill patients: a systematic review

Commentary

Hippocrates is alive and weaning in Brazil

Research

Early drotrecogin alpha (activated) administration in severe sepsis is associated with lower mortality: a retrospective analysis of the Canadian ENHANCE cohort