Nosocomial pneumonia in elderly patients following cardiac surgery

• Published in: Respiratory medicine Vol. 100; no. 4; pp. 729 - 736
• Main Authors: El Solh, Ali A., Bhora, Milapchand, Pineda, Lilibeth, Dhillon, Rajwinder
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.04.2006; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiac surgery; Cardiac Surgical Procedures - statistics & numerical data; Cardiovascular disease; Case-Control Studies; Cross Infection - epidemiology; Cross Infection - microbiology; Elderly; Female; General aspects; Heart surgery; Hospitals; Human infectious diseases. Experimental studies and models; Humans; Infectious diseases; Intensive Care Units; Logistic Models; Male; Matched-Pair Analysis; Medical sciences; Nosocomial pneumonia; Pain control; Pneumology; Pneumonia - epidemiology; Pneumonia - microbiology; Postoperative period; Reintubation; Risk Factors; Transfusion; Transfusion; Cardiac surgery; Pain control; Nosocomial pneumonia; Elderly; Reintubation; Human; Lung disease; Nosocomial infection; Pneumonia; Respiratory disease; Control; Pain
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2005.07.011

To identify modifiable risk factors of nosocomial pneumonia (NP) in elderly patients post-cardiac surgery. A case-control study. Post-operative intensive care unit of a tertiary-level university affiliated hospital. 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 1 s (FEV 1), and ejection fraction. 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. 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 ). 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.