Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe.
Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe.
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DOI：
10.1186/cc7896
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
European Workgroup of Cardiothoracic Intensivists
中科院分区：
文献类型：
--
作者：
Hortal J;Muñoz P;Cuerpo G;Litvan H;Rosseel PM;Bouza E;European Study Group on Nosocomial Infections;European Workgroup of Cardiothoracic Intensivists
接受大心脏手术（MHS）的患者代表了一个特殊的亚群，有院内感染的风险。术后感染是MHS后的主要非心脏并发症，与发病率、医院资源使用和死亡率的增加明显相关。我们的目的是确定在欧洲接受MHS的患者中呼吸机相关性肺炎（VAP）的发病率、病因、危险因素和结局。我们的研究是一项在欧洲进行MHS的患者中进行的前瞻性研究，这些患者怀疑患有VAP。在一个月的时间内，参与单位提交了一份所有接受过MHS的患者的方案。总共有8个不同欧洲国家的25家医院参与了这项研究。接受MHS干预的患者人数为986人。15例患者因方案违背而被排除。43例（4.4%）患者检测到一种或多种医院感染。VAP是最常见的医院感染（2.1%;每1000天机械通气13.9次）。本研究中引起VAP的微生物为：肠杆菌科（45%）、铜绿假单胞菌（20%）、耐甲氧西林金黄色葡萄球菌（10%）和一系列其他微生物。我们确定了以下VAP的重要独立危险因素：（比值比（OR）= 6.22; 95%置信区间（CI）= 1.69至22.89），输血单位数（OR = 1.08/单位输血; 95% CI = 1.04 - 1.13）和需要再次干预（OR = 6.65; 95% CI = 2.10 - 21.01）。VAP患者在重症监护室的中位住院时间显著长于无VAP患者（23天vs 2天）（P < 0.001）。VAP患者的死亡率明显高于VAP患者（35%比2.3%）（P < 0.001）。接受主动脉手术的患者和需要多次输血或再次干预的复杂干预后病程的患者构成了可能需要更积极预防措施的高危人群。
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. 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. 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%). 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.
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DOI：
10.1164/ajrccm/139.4.877
发表时间：
1989-04-01
期刊：
AMERICAN REVIEW OF RESPIRATORY DISEASE
影响因子：
--
作者：
FAGON, JY;CHASTRE, J;GIBERT, C
通讯作者：
GIBERT, C
影响因子：
2.8
作者：
Pawar, M;Mehta, Y;Trehan, N
通讯作者：
Trehan, N
影响因子：
--
作者：
MCCABE, WR;JACKSON, GG
通讯作者：
JACKSON, GG
影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
通讯作者：
Salamon, R
影响因子：
9.6
作者：
Rello, J;Ollendorf, DA;Kollef, MH
通讯作者：
Kollef, MH