Nosocomial Pneumonia in Elderly Patients Following Cardiac Surgery

Bhora, Milapchand; Pineda, Lilibeth A.; Dhillon, Rajwinder S.

doi:10.1378/chest.128.4_meetingabstracts.184s

Cited by 10 publications

(11 citation statements)

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“…As shown in other surgical populations, RBCs were an independent risk factor in a dose‐dependent fashion for postoperative infections in this cohort of patients undergoing liver transplantation 55‐62. Each unit of transfused RBCs increased the risk of postoperative infection by 7%.…”

Section: Discussionsupporting

confidence: 72%

Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation

Benson¹,

Burton²,

Austin³

et al. 2011

Liver Transpl

120

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Patients with chronic liver disease have an increased risk of developing transfusion-related acute lung injury (TRALI) from plasma-containing blood products. Similarly, red blood cell transfusions have been associated with postoperative and nosocomial infections in surgical and critical care populations. Patients undergoing liver transplantation receive large amounts of cellular and plasma-containing blood components, but it is presently unclear which blood components are associated with these postoperative complications. A retrospective cohort study of 525 consecutive liver transplant patients revealed a perioperative TRALI rate of 1.3% (7/525, 95% confidence interval ¼ 0.6%-2.7%), which was associated with increases in the hospital mortality rate [28.6% (2/7) versus 2.9% (15/518), P ¼ 0.02] and the intensive care unit length of stay [2 (1-11 days) versus 0 days (0-2 days), P ¼ 0.03]. Only high-plasma-containing blood products (plasma and platelets) were associated with the development of TRALI. Seventy-four of 525 patients (14.1%) developed a postoperative infection, and this was also associated with increased in-hospital mortality [10.8% (8/74) versus 2.0% (9/451), P < 0.01] and a prolonged length of stay. Multivariate logistic regression determined that the number of transfused red blood cell units (adjusted odds ratio ¼ 1.08, 95% confidence interval ¼ 1.02-1.14, P < 0.01), the presence of perioperative renal dysfunction, and reoperation were significantly associated with postoperative infection. In conclusion, patients undergoing liver transplantation have a high risk of developing postoperative complications from blood transfusion. Plasma-containing blood products were associated with the development of TRALI, whereas red blood cells were associated with the development of postoperative infections in a dosedependent manner. Liver Transpl 17:149-158, 2011. V C 2011 AASLD.Received July 25, 2010; accepted October 10, 2010.Infectious complications are among the most common causes of early death after liver transplantation. 1-5 Both postoperative pneumonia and surgical site infections have been linked to intraoperative red blood cell (RBC) and plasma transfusions in liver transplant patients and other postoperative patient populations. 4,[6][7][8][9][10][11][12] However, the incidence and distribution of all postoperative infections as well as the type and prestorage characteristics of the blood products associated with these infections in the liver transplant population are not clearly defined.Abbreviations: ALI, acute lung injury; CI, confidence interval; CXR, chest X-ray; DRI, donor risk index; ICU, intensive care unit; MELD, Model for End-Stage Liver Disease; OR, odds ratio; RBC, red blood cell; RR, relative risk; TEG, thromboelastogram; TRALI, transfusion-related acute lung injury.

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Section: Discussionsupporting

confidence: 72%

Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation

Benson¹,

Burton²,

Austin³

et al. 2011

Liver Transpl

120

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“…Post‐operative pneumonia, in particular, has been the subject of numerous studies, reporting variable incidence rates, from 2.4% to 10.7% . Many risk factors for developing pneumonia post‐operatively have been identified and include: age, chronic pulmonary disease, heart failure, female gender, duration of surgery and cardiopulmonary bypass, duration of mechanical ventilation, re‐intubation, transfusion of blood products and emergency surgery . Most of these factors are not amenable to modification.…”

Section: Introductionmentioning

confidence: 99%

Infections and outcomes after cardiac surgery—The impact of outbreaks traced to transesophageal echocardiography probes

Vesteinsdottir

Helgason

Sverrisson

et al. 2019

Acta Anaesthesiol Scand

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Background Infections are a frequent complication of cardiac surgery. The intraoperative use of transesophageal echocardiography (TEE) may be an underrecognized risk factor for post‐operative infections. The aim of this study was to investigate infection rates and outcomes after cardiac surgery in a nationwide cohort, especially in relation to periods where surface damaged TEE probes were used. Methods This was a retrospective, observational study at Landspitali University Hospital. All consecutive cardiac surgery patients from 1 January 2013 to 31 December 2017 were included. Patients’ charts were reviewed for evidence of infection, post‐operative complications or death. Results During the study period, 973 patients underwent cardiac surgery at Landspitali and 198 (20.3%) developed a post‐operative infection. The most common infections were: Pneumonia (9.1%), superficial surgical site (5.7%), bloodstream (2.8%) and deep sternal wound (1.7%). Risk factors for developing an infection included: The duration of procedure, age, insulin‐dependent diabetes, EuroScore II, reoperation for bleeding and an operation in a period with a surface damaged TEE probe in use. Twenty‐two patients were infected with a multidrug resistant strain of Klebsiella oxytoca, 10 patients with Pseudomonas aeruginosa and two patients developed endocarditis with Enterococcus faecalis. All three pathogens were cultured from the TEE probe in use at respective time, after decontamination. The 30‐day mortality rate in the patient cohort was 3.2%. Conclusions The intraoperative use of surface damaged TEE probes caused two serious infection outbreaks in patients after cardiac surgery. TEE probes need careful visual inspection during decontamination and probe sheaths are recommended.

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“…Although the high incidence of infectious diseases among abusers is commonly attributed to increased pathogen exposure or insalubrious behaviors, opioids exert potent immunomodulatory effects that may further enhance infection susceptibility. Controlled studies in humans demonstrate that morphine produces immunosuppressive effects in healthy, nondrug-using subjects (Yeager et al, 1995), and clinical reports indicate that higher doses of opioid analgesics are associated with greater frequencies of infectious complications among burn victims and patients that underwent cardiac surgery (El Solh et al, 2006;Schwacha et al, 2006). Thus, the use of opioids, whether for therapeutic or recreational purposes, may directly influence resistance to infectious diseases.…”

mentioning

confidence: 99%

Evidence for the Nucleus Accumbens as a Neural Substrate of Heroin-Induced Immune Alterations

Saurer

Ijames²,

Lysle³

2009

J Pharmacol Exp Ther

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Administration of opioid drugs such as heroin produces several immunosuppressive effects, including decreases in natural killer (NK) cell activity, lymphocyte proliferative responses, and nitric oxide production. Interestingly, opioids have been shown to alter many immune parameters indirectly by modulating the immunoregulatory actions of the central nervous system. Recently, it has been demonstrated that morphine inhibits NK cell activity through a neural pathway that requires the activation of dopamine D 1 receptors in the nucleus accumbens shell. The present study examined whether the nucleus accumbens also mediates the effects of heroin, a more commonly abused opioid, on several parameters of immune status in Lewis rats. The results showed that bilateral administration of the dopamine D 1 receptor antagonist R-(ϩ)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine hydrochloride (SCH-23390; 0.015 and 0.15 g/side) into the nucleus accumbens shell blocked decreases in splenic NK activity produced by heroin (3 mg/kg s.c.) but did not attenuate the suppression of splenocyte proliferative responses to concanavalin-A or lipopolysaccharide (LPS). A subsequent experiment was performed to evaluate the effect of D 1 receptor antagonism on LPS-induced expression of inducible nitric-oxide synthase (iNOS) in vivo. These results showed that intra-accumbens SCH-23390 administration prevented heroin-induced reductions of iNOS mRNA expression in spleen, liver, and lung tissues and attenuated the suppression of nitric oxide levels in plasma. Collectively, these findings indicate that nucleus accumbens dopamine D 1 receptors are critically involved in heroin-induced immune alterations.Opioid drug use is associated with adverse health consequences. Heroin abusers display abnormalities in basic immune parameters and have high rates of viral, bacterial, and fungal infections (Louria et al., 1967;Govitrapong et al., 1998). Although the high incidence of infectious diseases among abusers is commonly attributed to increased pathogen exposure or insalubrious behaviors, opioids exert potent immunomodulatory effects that may further enhance infection susceptibility. Controlled studies in humans demonstrate that morphine produces immunosuppressive effects in healthy, nondrug-using subjects (Yeager et al., 1995), and clinical reports indicate that higher doses of opioid analgesics are associated with greater frequencies of infectious complications among burn victims and patients that underwent cardiac surgery (El Solh et al., 2006;Schwacha et al., 2006). Thus, the use of opioids, whether for therapeutic or recreational purposes, may directly influence resistance to infectious diseases.In animal models, morphine has been shown to suppress a variety of immune parameters, but the mechanisms underlying these effects are not fully understood Lockwood et al., 1994). Opioids modulate immunity in a highly complex manner by interacting with opioid receptors expressed by multiple cell types throughout the body. For exa...

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Nosocomial Pneumonia in Elderly Patients Following Cardiac Surgery

Cited by 10 publications

References 0 publications

Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation

Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation

Infections and outcomes after cardiac surgery—The impact of outbreaks traced to transesophageal echocardiography probes

Evidence for the Nucleus Accumbens as a Neural Substrate of Heroin-Induced Immune Alterations

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