"Risk factors for ventilator-associated pneumonia following cardiac surgery: case-control study"

Nasreen Hassoun-Kheir; Khetam Hussein; Zaher Abboud; Yaniv Raderman; Lana Abu-Hanna; Abed Darawshe; Gil Bolotin; Mical Paul

doi:10.1016/j.jhin.2020.04.009

"Risk factors for ventilator-associated pneumonia following cardiac surgery: case-control study"

J Hosp Infect. 2020 Apr 10:S0195-6701(20)30184-5. doi: 10.1016/j.jhin.2020.04.009. Online ahead of print.

Authors

Nasreen Hassoun-Kheir¹, Khetam Hussein², Zaher Abboud³, Yaniv Raderman³, Lana Abu-Hanna³, Abed Darawshe⁴, Gil Bolotin⁵, Mical Paul²

Affiliations

¹ Infectious diseases and infection-control unit, Rambam Health Care Campus (Haifa, Israel); Technion - Israel Institute of Technology (Haifa, Israel). Electronic address: N_hassoun@rambam.health.gov.il.
² Infectious diseases and infection-control unit, Rambam Health Care Campus (Haifa, Israel); Technion - Israel Institute of Technology (Haifa, Israel).
³ Technion - Israel Institute of Technology (Haifa, Israel).
⁴ Cardiac surgery department, Rambam Health Care Campus (Haifa, Israel).
⁵ Technion - Israel Institute of Technology (Haifa, Israel); Cardiac surgery department, Rambam Health Care Campus (Haifa, Israel).

PMID: 32283174
DOI: 10.1016/j.jhin.2020.04.009

Abstract

Background: Ventilator-associated pneumonia (VAP) following cardiac surgery is a preventable complication associated with adverse outcomes.

Aims: We aimed to assess risk factors and outcomes of VAP following cardiac surgery.

Methods: A matched 1:3 case:control study, including adult patients undergoing cardiac surgery through sternotomy between Sep-2014 to Mar-2017 was conducted in a tertiary-care hospital in Israel. Cases included all patients developing VAP within 30 days after surgery, defined using consensus criteria. Controls were matched for age, gender and surgery type. Operative data were collected prospectively, other data were collected retrospectively. Cox regression was used for adjusted analysis of matched data.

Findings: Out of 946 operated patients, we identified 57 patients with VAP after cardiac surgery (17.7 episodes per 1000 ventilator-days) matched to 149 controls. Significant independent risk factors for VAP included congestive heart failure (OR 2.357 95%CI 1.052-5.281), Chest re-exploration in ICU (OR 10.213 95%CI: 2.235-46.678), preoperative glucose levels (OR 1.1010 per 1 mg/dl increase 95%CI: 1.004-1.019) intraoperative red blood cell transfusions (OR 1.542 per 1 unit 95%CI: 1.109-2.094) and pulmonary hypertension (OR 2.261 95%CI 1.048-6.554). VAP was most commonly caused by Gram-negative pathogens. VAP was associated with higher mortality, longer length of stay, longer need for ventilator support and longer stay in ICU setting.

Conclusions: Postoperative VAP in cardiac surgery patients is associated with severe clinical outcomes. We identified risk factors that can aid in preventive measures implementation for high risk patients.

Keywords: cardiac surgery; risk factors; ventilator-associated pneumonia.