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Ventilator-associated pneumonia after procedures in cardiac surgery

Introduction

Surveillance of hospital-acquired infections in intensive care wards is a very important but time-consuming process requiring involvement of all medical personnel [1]. This means published data on infections after cardiac surgery are rather limited [2]. The aim of this study was to analyze the epidemiology and etiology of ventilator-associated pneumonia (VAP) following coronary surgery in ICU patients.

Methods

The surveillance was based on the active method. Cases of infections were detected by the hospital Infection Control Team in cooperation with the unit personnel in accordance with Centers for Disease Control definitions during 2007. Data on surgical site infections (SSI; 33 cases) served as the background for validation of VAP surveillance.

Results

Altogether 53 VAP cases after 2,170 surgical events were detected. The ventilator utilization ratio was 0.52. The total cumulative VAP incidence rate was 2.2% and the ventilator-associated hospital-acquired pneumonia rate was 18.3/1,000 ventilator-days; mortality was 1.9%. The total cumulative incidence SSI rate was 1.4%. Etiological factors of VAP were Gram-negative bacilli (Pseudomonas aeruginosa – 10.4%, Escherichia coli –12.5%, Klebsiella pneumoniae – 16.7%) and Candida albicans.

Conclusion

In the analyzed setting, in which surveillance of SSI has been run since 2002, detected SSI incidence rates are similar to those reported in the National Nosocomial Infections Surveillance and Krankenhaus Infectionen Surveillance System programs [3, 4]. However, obtained data on the epidemiology of VAP are different. Also, there are differences in both the epidemiology and microbiology of VAP in this hospital and results reported from other cardiac surgery wards. This indicates a necessity for introducing effective surveillance of hospital-acquired pneumonia after cardiac surgery procedures in the ICU.

References

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    Eggiman P, Hugonnet S, Sax H, et al.: VAP: caveats for benchmarking. Intensive Care Med 2003, 29: 2086. 10.1007/s00134-003-1991-9

  2. 2.

    Dupont H, Montravers P, Gauzit R, et al.: Outcome of postoperative pneumonia in the Eole study. Intensive Care Med 2003, 29: 179.

  3. 3.

    Edwards JR, Peterson KD, Andrus ML: National Heathcare Saftey Network report. Am J Infect Control 2007, 35: 290. 10.1016/j.ajic.2007.04.001

  4. 4.

    Finkelstein R, Rabino G, Mashiah T, et al.: Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program. Am J Infect Control 2005, 33: 450. 10.1016/j.ajic.2005.07.002

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Acknowledgements

Partially financed by K/ZDS/000649.

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Wojkowska-Mach, J., Baran, M., Drwila, R. et al. Ventilator-associated pneumonia after procedures in cardiac surgery. Crit Care 13, P298 (2009). https://doi.org/10.1186/cc7462

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Keywords

  • Klebsiella Pneumoniae
  • National Nosocomial Infection Surveillance
  • Hospital Infection Control
  • Infection Control Team
  • Intensive Care Ward