Ventilator-Associated Pneumonia: Comparing Cadaveric Liver Transplant and Non-Transplant Surgical Patients

Abstract

SUMMARY -Ventilator-associated pneumonia is a frequent complication in intensive care surgical patients, particularly those with high severity scores on admission. We studied the incidence and clinical outcome of ventilator-associated pneumonia among patients undergoing major general surgery procedures and those undergoing cadaveric liver transplantation in our hospital. Patients with the intensive care unit stay longer than four days having undergone surgery or transplantation and mechanically ventilated for more than 48 hours were included in the study. Ventilator-associated pneumonia diagnosis was based on a combination of radiological signs (progressive infi ltrate on chest radiograph), clinical signs (fever >38.3 °C, leukocytes >12×10 9 /mL) and microbiological data (positive culture from tracheal aspiration >10 5 or bronchoalveolar lavage >10 4 colonies/mL). Medical records of 1037 patients were reviewed and 157 patients were found to have been mechanically ventilated for more than 48 hours: 62 transplanted and 95 non-transplanted. Only 39 (24.84%) patients matched the criteria for ventilator-associated pneumonia. Th ere were no diff erences in sex, age, duration of mechanical ventilation, length of stay or outcome between the two groups. However, the main diff erence was the mean severity score on admission (Simplifi ed Acute Physiology Score II) which was higher among non-transplant patients (42±16 vs. 31±9; p=0.03). Gram-negative bacteria were the leading causative agents (82.03%) and were multidrug-resistant. In the intensive care surgical population, transplantation per se does not seem to increase patient risk for either ventilator-associated pneumonia acquisition or worse outcomes.

Stress Ulcer Prophylaxis as a Risk Factor for Tracheal Colonization and Hospital-Acquired Pneumonia in Intensive Care Patients: Impact on Latency Time for Pneumonia

“…Similar findings were observed by Brusich et al . ( 48 ), who found that gram-negative bacteria were the leading causative agents (82.03%) of VAP and were even multidrug-resistant. Thus, we must also consider fungi, especially in immunocompromised patients ( 49 ).…”