Artificial ventilation as a risk factor causing hospital-acquired pneumonia (hap) in patients treated in the intensive care unit of a cardiac surgery hospital

View or download the full article: 
PDF icon health-risk-analysis-2022-1-11.pdf
UDC: 
616.12.-089.168.1-085.816.2-06: 616.24-002.1-022.369
DOI: 
10.21668/health.risk/2022.1.11.eng
Authors: 

V.I. Sergevnin1, L.G. Kudryavtseva2, P.V. Lazarkov1,2

Organization: 

1Perm State Medical University named after Academician E.A. Wagner, 26 Petropavlovskaya Str., Perm, 614990, Russian Federation
2S.G. Sukhanov’s Federal Center for Cardiovascular Surgery, 35 Marshala Zhukova Str., Perm, 614013, Russian Federation

Abstract: 

Hospital-acquired pneumonia (HAP) is the most common purulent septic infection among patients treated in intensive care units (ICUs) at cardiac surgery hospitals. Risk factors that can cause HAP, in particular, contribution made by artificial ventilation (AV) have not been studied enough. Our objective was to examine an epidemiological role played by AV in HAP occurrence among children and adults treated in the intensive care unit at a cardiac surgery hospital. We examined health records of 5318 patients (503 children and 4815 adults) who had a cardiac surgery due to congenital heart diseases or acquired cardiovascular disorders over 1 year. HAP was identified according to the epidemiological standards for case definition. Besides, we took into account pre-nosologic HAP cases, that is, patients already having certain pathological symptoms typical for purulent septic infections, but still, even combined, these symptoms were not enough to diagnose a typical HAP case in accordance with the standard case definition. Data were statistically analyzed by calculating the χ2 goodness-of-fit test. We established that most HAP cases occurred among patients of a cardiac surgery hospital who were being treated in the intensive care unit after a surgery. We proved AV to be the leading risk factor causing HAP. Higher incidence rates of HAP were detected among children in comparison with adults. We showed that Klebsiella pneumoniaе was the primary infectious agent that caused HAP. Particularly, background respiratory diseases and diseases of the central nervous system were proven to be endogenous risk factors of developing HAP among patients treated in the ICU at a cardiac surgery hospital.

Keywords: 
cardiac surgery hospital, intensive care unit, hospital-acquired pneumonia, risk groups, etiology, role played by artificial ventilation
Sergevnin V.I., Kudryavtseva L.G., Lazarkov P.V. Artificial ventilation as a risk factor causing hospital-acquired pneumonia (HAP) in patients treated in the intensive care unit of a cardiac sur-gery hospital. Health Risk Analysis, 2022, no. 1, pp. 97–103. DOI: 10.21668/health.risk/2022.1.11.eng
References: 
  1. Svetlichnaya Y.S., Kolosovskaya E.N., Kaftireva L.А., Zueva L.P., Daryina M.G., Zakhvatova A.S. Hospital infection epidemic in the intensive care unit of a general hospital. VICh-infektsiya i immunosupressii, 2016, vol. 8, no. 4, pp. 60–65. DOI: 10.22328/2077-9828-2016-8-4-60-65
    (in Russian).
  2. Abdelrazik O.A., Salah Abdelazim M. Ventilator-associated pneumonia in adult intensive care unit prevalence and complications. Egypt. J. Crit. Care Med., 2017, vol. 5, no. 2, pp. 61–63. DOI: 10.1016/j.ejccm.2017.06.001
  3. Arefyeva L.I., Gorskaya E.M., Savostiyanova O.A., Senchenko O.R., Gabrieliyan N.I. The infectious complications of bacterial nature in cardio-vascular surgery. Rossiiskii meditsinskii zhurnal, 2013, no. 3, pp. 36–42 (in Russian).
  4. Gelijns A.C., Moskowitz A.J., Acker M.A., Argenziano М., Geller N.L., Puskas J.D., Perrault L.P., Smith P.K. [et al.]. Management practices and major infections after cardiac surgery. J. Am. Coll. Cardiol., 2014, vol. 64, no. 4, pp. 372–381. DOI: 10.1016/j.jacc.2014.04.052
  5. Orlova O.A., Akimkin V.G., Chistova A.V., Efremova N.P. Epidemiological characteristics of infections associated with delivery of health care in surgical departments. Epidemiologiya i in-fektsionnye bolezni, 2014, vol. 19, no. 6, pp. 20–27 (in Russian).
  6. Gelfand B.R., Belotserkovskiy B.Z., Milukova I.A., Gelfand E.B. Epidemiology and nosological structure of nosocomial infections in intensive care unit оf multitype hospital. Infektsii v khirurgii, 2014, vol. 12, no. 4, pp. 24–36 (in Russian).
  7. Ding C., Zhang Y., Yang Z., Wang J., Jin A., Wang W., Chen R., Zhan S. Incidence, temporal trend and factors associated with ventilator-associated pneumonia in mainland China: a systematic review and meta-analysis. BMC Infect. Dis., 2017, vol. 17, no. 1, pp. 468. DOI: 10.1186/s12879-017-2566-7
    1. Lobacheva G.V., Popov D.A., Rakhimov A.A., Kolesnikova E.A. IVL-assotsiirovannye pnevmonii v kardioreanimatsionnom otdelenii [Ventilator-associated pneumonia in the cardiac intensive care unit]. Klinicheskaya fiziologiya krovoobrashcheniya, 2014, no. 3, pp. 71–75 (in Russian).
  8. O'Keefe S., Williams K., Legare J.-F. Hospital-acquired infections after cardiac surgery and current physician practices: a retrospective cohort study. J. Clin. Med. Res., 2017, vol. 9, no. 1, pp. 10–16. DOI: 10.14740/jocmr2637w
  9. Chiurazzi C., Motos-Galera A., Torres A. Early identification of ventilator-associated pneumonia causative pathogens: focus on the value of gram-stain examination. Annual update in Intensive Care and Emergency Medicine 2015. Springer, Charm, 2015, pp. 3–14. DOI: 10.1007/978-3-319-13761-2_1
  10. Vijay G., Mandal А., Sankar J., Kapil А., Lodha R., Kabra S.K. Ventilator associated pneumonia in pediatric intensive care unit: incidence, risk factors and etiological agents. Indian J. Pediatr., 2018, vol. 85, no. 10, pp. 861–866. DOI: 10.1007/s12098-018-2662-8
  11. Papazian L., Klompas М., Luyt C.-E. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med., 2020, vol. 46, no. 5, pp. 888–906. DOI: 10.1007/s00134-020-05980-0
  12. Chang L., Dong Y., Zhou P. Investigation on risk factors of ventilator-associated pneumonia in acute cerebral hemorrhage patients in intensive care unit. Can. Respir. J., 2017, vol. 2017, pp. 7272080. DOI: 10.1155/2017/7272080
  13. Zubair S., Ali H., Raza S.F., Warind J.A., Beg A.E., Bushra R. Assessment of frequency and transience rate for ventilator-associated pneumonia (VAP) in geriatric patients in tertiary care settings of Karachi, Pakistan. J. Coll. Physicians Surg. Pak., 2018, vol. 28, no. 7, pp. 536–540. DOI: 10.29271/jcpsp.2018.07.536
  14. Nozokomial'naya pnevmoniya u vzroslykh: Rossiiskie natsional'nye rekomendatsii [Hospital-acquired pneumonia in adults: Russian national guidelines]. In: Academician B.R. Gelfand ed. Moscow, MIA, 2016, 176 p. (in Russian).
  15. Reilly J.S., Price L., Godwin J., Cairns S., Hopkins S., Cookson B., Malcolm B., Hughes G.J. [et al.]. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals – protocol version 4.3. European Centre for Disease Prevention and Control, 2012, Chapter 3, pp. 1–108.
  16. Sergevnin V.I., Klyucharyova N.M. Pre-epidemic diagnosis of hospital-acquired purulent-septic infections morbidity. Zdorov'e naseleniya i sreda obitaniya, 2018, vol. 298, no. 1, pp. 27−29. DOI: 10.35627/2219-5238/2018-298-1-27-29 (in Russian).
  17. Sergevnin V.I., Kudryavtseva L.G., Pegyshina O.G., Volkova E.O., Reshetnikova N.I. Group Incidence by Purulent-Septic Infections of Clebsiellous Etiology in Cardiosurgical Patients. Epidemiologiya i vaktsinoprofilaktika, 2020, vol. 19, no. 1, pp. 90–98. DOI: 10.31631/2073-3046-2020-19-1-90-98 (in Russian).
  18. Jimenez-Trujillo I., Jimenez-Garcia R., de Miguel-Diez J., de Miguel-Yanes J.M., Hernan-dez-Barrera V., Mendez-Bailon M., Pérez-Farinós N., Salinero-Fort M.-Á. [et al.]. Incidence, char-acteristic and outcomes of ventilator-associated pneumonia among type 2 diabetes patients: an observational population-based study in Spain. Eur. J. Intern. Med., 2017, no. 40, pp. 72–78. DOI: 10.1016/j.ejim.2017.01.019
  19. Sergevnin V.I., Kudryavtseva L.G., Zolotukhina A.I. Frequency and Risk Factors of Purulent Septic Infection among Adults after Different Types of an Open Heart Operations. Epidemiologiya i vaktsinoprofilaktika, 2020, vol. 19, no. 5, pp. 34–40. DOI: 10.31631/2073-3046-2020-19-5-34-41 (in Russian).
Received: 
14.01.2022
Approved: 
25.02.2022
Accepted for publication: 
11.03.2022

You are here

Home