title: Nosocomial pneumonia in elderly patients following cardiac surgery.
abstract: OBJECTIVE
  To identify modifiable risk factors of nosocomial pneumonia (NP) in elderly patients post-cardiac surgery.
  
  
  METHODS
  A case-control study.
  
  
  METHODS
  Post-operative intensive care unit of a tertiary-level university affiliated hospital.
  
  
  METHODS
  Seventy three case-control pairs. Case patients referred to elderly patients who developed pneumonia post-cardiac surgery. Controls subjects were matched for age, gender, type of surgery, forced expiratory volume in 1s (FEV(1)), and ejection fraction.
  
  
  METHODS
  Baseline sociodemograpahic information, Charlson Comorbidity Index score, intra- and post-operative data were collected. When suspected, the presence of NP was confirmed by quantitative culture of protected bronchoalveolar lavage fluid 10(3) colony forming unit/ml or positive blood/pleural fluid culture identical to that recovered from respiratory samples.
  
  
  RESULTS
  The incidence of NP in elderly post-heart surgery was 8.3%. The mean duration after heart surgery to the occurrence of pneumonia was 7.2+/-4.9 days. Four variables were found to be significantly related to the development of NP by multivariate analysis: Charlson Index >2 (adjusted odds ratio [AOR] 4.7; 95% confidence interval [CI], 1.9-11.4; P<0.001), reintubation (AOR 6.2; 95% CI, 1.1-36.1; P=0.04), transfusion 4 units of PRBC (AOR 2.8; 95% CI, 1.2-6.3; P=0.01), and the mean equivalent daily dose of morphine (AOR 4.6; 95% CI, 1.4-14.6; P=0.01).
  
  
  CONCLUSIONS
  Although there are limited effective measures to lessen the burden of comorbidities, avoiding reintubation, finding a substitute to allogenic blood transfusion, and improved assessment of pain management could reduce the rate of NP in the post-operative period of cardiac surgery in the elderly population.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, USA. solh@buffalo.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: El Solh
authors.forename: Milapchand
authors.initials: M
authors.lastname: Bhora
authors.forename: Lilibeth
authors.initials: L
authors.lastname: Pineda
authors.forename: Rajwinder
authors.initials: R
authors.lastname: Dhillon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D011014:Pneumonia / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors