title: Hospital-acquired pneumonia in patients undergoing coronary artery bypass graft; comparison of the center for disease control clinical criteria with physicians' judgment.
abstract: BACKGROUND
  Following coronary artery bypass graft (CABG), patients are at high risk (3.2%-8.3%) for developing hospital-acquired pneumonia (HAP) with mortality rate of 24% to 50%. Some of routine features in patients undergoing CABG are similar to clinical criteria of Center of Disease Control (CDC) for diagnosis of pneumonia. This may lead to over-diagnosis of pneumonia in these patients.
  
  
  OBJECTIVE
  This study aimed to assess the frequency of CDC criteria for diagnosis of pneumonia in patients undergoing CABG.
  
  
  METHODS
  This study was performed on CABG candidates admitted to post cardiac surgery Intensive Care Unit (ICU) in a six-month period. Patient's records, Chest-X-Ray, and Laboratory tests were assessed for PNU1-CDC criteria for HAP diagnosis. At the same time, a physician who was unaware of the study protocol assessed the clinical diagnosis. Then the results were compared with CDC criteria-based diagnosis.
  
  
  RESULTS
  Of total 300 patients, 9 (3%) met CDC criteria for diagnosis of pneumonia while none of the cases were diagnosed as HAP according to the physicians' clinical diagnosis. All nine patients were discharged with proper general condition and no need of antibiotic therapy. This study showed that loss of consciousness, tachypnea, dyspnea, PaO2 < 60 mm Hg, PaO2/FiO2 < 240, and local infiltration in 24 hours of operation were misleading features of CDC criteria, which were not considered in physicians' clinical judgment to establish the diagnosis.
  
  
  CONCLUSIONS
  Our findings suggest that in Post-CABG patients, physicians could judge the occurrence of HAP more accurately in comparison to making the diagnosis based on CDC criteria alone. Expert physician may intentionally do not take some of these criteria into account according the patients' course of disease. Therefore, it is suggested that the value of these criteria in special group of patients like those undergoing CABG should be re-evaluated.
authors.affiliation: Internal Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahboubeh
authors.initials: M
authors.lastname: Baghban
authors.affiliation: Internal Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Omalbanin
authors.initials: O
authors.lastname: Paknejad
authors.affiliation: Anesthesia and Critical Care Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Fardin
authors.initials: F
authors.lastname: Yousefshahi
authors.affiliation: Internal Medicine Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Keivan
authors.initials: K
authors.lastname: Gohari Moghadam
authors.affiliation: Department of Basic and Clinical Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Payvand
authors.initials: P
authors.lastname: Bina
authors.affiliation: Anesthesia and Critical Care Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Saghar
authors.initials: S
authors.lastname: Samimi Sadeh
keywords: Coronary Artery Bypass; Graft; Hospital Infection; Pneumonia