title: Ventilator associated pneumonia following liver transplantation: Etiology, risk factors and outcome.
abstract: OBJECTIVE
  To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients undergoing orthotopic liver transplantation (OLT).
  
  
  METHODS
  This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria.
  
  
  RESULTS
  VAP occurred in 18 (7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation (MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae (79%). Univariate logistic analysis showed that model for end-stage liver disease (MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariate analysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP.
  
  
  CONCLUSIONS
  Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development.
authors.affiliation: Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Siniscalchi
authors.affiliation: Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Aurini
authors.affiliation: Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Benini
authors.affiliation: Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Gamberini
authors.affiliation: Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nava
authors.affiliation: Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.affiliation: Antonio Siniscalchi, Lucia Aurini, Beatrice Benini, Lorenzo Gamberini, Stefano Faenza, Division of Anesthesiology, Department of General Surgery of Sant'Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Faenza
keywords: Infection; Liver transplantation; Perioperative period; Ventilator associated pneumonia