title: Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance.
abstract: OBJECTIVE
  To determine the frequency, etiology, and risk factors of ventilator-associated pneumonia (VAP) and purulent tracheobronchitis (TBX) in patients who have undergone heart surgery. To study the predictive role of systematic surveillance cultures.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Heart surgery intensive care unit.
  
  
  METHODS
  Intubated heart surgical patients.
  
  
  METHODS
  Systematic tracheal aspirate and protected brush catheter cultures of all intubated patients.
  
  
  RESULTS
  Studied were the frequency of lower respiratory tract infection in ventilated patients and the role of surveillance cultures. The frequency of VAP was 7.87% (34.5 per 1,000 days of mechanical ventilation), and the criteria for purulent tracheobronchitis was fulfilled by 8.15% of patients (31.13 per 1,000 days of mechanical ventilation). After multivariate analysis, the variables independently associated with the development of respiratory tract infection were central nervous system disorder (relative risk [RR] = 4.7), ulcer disease (RR = 3.6), New York Heart Association score >/=3 (RR = 4), need for mechanical circulatory support (RR = 6.8), duration of mechanical ventilation >96 hrs (RR = 12.3), and reintubation (RR = 63.7). Mortality in our study was as follows: VAP patients, 57.1%; purulent tracheobronchitis patients, 20.7%; colonized patients, 11.5%; and noncolonized patients, 1.6%. Regular surveillance cultures were taken from all ventilated patients to assess the anticipative value of the cultures in predicting respiratory tract infection. A total of 1,626 respiratory surveillance samples were obtained. Surveillance cultures effectively predicted only one episode of VAP and one of tracheobronchitis.
  
  
  CONCLUSIONS
  Patients undergoing heart surgery have a high frequency of VAP. VAP is associated with a poor prognosis. In this study, surveillance cultures failed as an anticipative diagnostic method.
authors.affiliation: Department of Clinical Microbiology and Infectious Disease, Hospital General Universitario Gregorio Marañón, Madrid, Spain. ebouza@microb.net
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.forename: Ana
authors.initials: A
authors.lastname: Pérez
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: M
authors.initials: M
authors.lastname: Jesús Pérez
authors.forename: Cristina
authors.initials: C
authors.lastname: Rincón
authors.forename: Carlos
authors.initials: C
authors.lastname: Sánchez
authors.forename: Pablo
authors.initials: P
authors.lastname: Martín-Rabadán
authors.forename: Mariano
authors.initials: M
authors.lastname: Riesgo
mesh_terms: D000368:Aged; D001431:Bacteriological Techniques; D015897:Comorbidity; D003422:Critical Care; D003428:Cross Infection / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000401:mortality*; D011159:Population Surveillance; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis; D012122:Ventilators, Mechanical / Q000009:adverse effects*