Clinical, Microbiological and Treatment Characteristics of Severe Postoperative Respiratory Infections: An Observational Cohort Study
Abstract
:1. Introduction
2. Material and Methods
2.1. Patient Enrolment
2.2. Data Collection
2.3. Definitions and Data Collection
2.4. Diagnostic Management
2.5. Microbiology
2.6. Statistical Analysis
3. Results
3.1. Demographics and Patient Baseline Characteristics
3.2. Microbiological Diagnostic Data
3.3. Microbiological Results
3.4. Antibiotic Treatment
3.5. Outcomes
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographic and Clinical Data | Total (N = 207) |
---|---|
Male, n (%) | 152 (73) |
Age (years), mean (SD) | 70 (13) |
ASA score, n (%) | |
ASA score I or II | 33 (16) |
ASA score III | 123 (59) |
ASA score IV | 51 (25) |
ARISCAT score, mean (SD) | 46 (19) |
Type of surgery, n (%) | |
Emergency surgery | 102 (49) |
Elective surgery | 105 (51) |
Surgical specialty, n (%) | |
Abdominal surgery | 108 (52) |
Thoracic surgery | 32 (16) |
Orthopedic and spine surgery | 18 (9) |
Vascular surgery | 16 (8) |
Neurosurgery | 12 (6) |
Urological surgery | 10 (5) |
Head and neck surgery | 3 (1) |
Others | 8 (4) |
Surgical incision site | |
Open upper abdominal | 97 (44) |
Peripheral | 40 (19) |
Laparoscopy | 25 (12) |
Open thoracotomy | 16 (8) |
Head and neck | 16 (8) |
Thoracoscopy | 7 (3) |
Open lower abdominal | 6 (3) |
Type of anesthesia, n (%) | |
General | 198 (96) |
Regional | 9 (4) |
Intraoperative mechanical ventilation (minutes), mean (SD) | 250 (133) |
Other clinical data | |
Type of pneumonia, n (%) | |
Hospital-acquired pneumonia | 132 (64) |
Hospital-acquired tracheobronchitis | 45 (22) |
Ventilator-associated pneumonia | 21 (10) |
Ventilator-associated tracheobronchitis | 9 (4) |
SOFA score, mean (SD) ª | 5 (3) |
Septic shock, n (%) ª | 80 (39) |
Sepsis, n (%) ª | 127 (61) |
Immune profile | |
C-reactive protein (mg/dL), mean (SD) | 20 (14) |
Pro-calcitonin (ng/mL), mean (SD) | 12 (28) |
White blood cell count (×103/mm3), mean (SD) | 14,584 (7614) |
PaO2/FiO2, mean (SD) | 234 (100) |
Mechanical ventilation, n (%) | |
Invasive mechanical ventilation | 101 (49) |
Non-invasive mechanical ventilation | 37 (18) |
Outcomes | |
ICU stay (days), mean (SD) | 26 (25) |
Hospital stay (days), mean (SD) | 48 (36) |
ICU mortality, n (%) | 40 (22) |
30-day mortality, n (%) | 51 (25) |
In-hospital mortality, n (%) | 69 (29) |
Total n, (%) | Non-Risk Factors MDR n, (%) | Risk Factors MDR n, (%) | |
---|---|---|---|
Gram-negative bacteria | |||
Pseudomonas spp. | 25 (14) | 4 (16) | 21 (14) |
MDR Pseudomonas aeruginosa | 16 (9) | 0 | 16 (10) |
Escherichia coli | 14 (8) | 1 (4) | 13 (9) |
Serratia spp. | 10 (6) | 1 (4) | 9 (6) |
Klebsiella spp. | 14 (8) | 6 (24) | 8 (5) |
ESBL-producer Enterobacterales | 14 (8) | 1 (4) | 13 (9) |
Carbapenemase-producing Enterobacterales | 1 (1) | 0 | 1 (1) |
Other Enterobacterales | 16 (9) | 3 (12) | 13 (9) |
Stenotrophomona maltophilia | 12 (7) | 0 | 12 (8) |
Haemophilus spp. | 10 (6) | 5 (20) | 5 (3) |
Acinetobacter spp. | 4 (2) | 0 | 4 (3) |
MDR Acinetobacter baumannii | 1 (1) | 0 | 1 (1) |
Miscellaneous | 11 (6) | 1 (4) | 10 (7) |
Gram-positive bacteria | |||
Staphylococcus aureus | 12 (7) | 2 (8) | 10 (7) |
Streptococcus pneumoniae | 4 (2) | 1 (4) | 3 (2) |
Methicillin-resistant S. aureus | 3 (2) | 0 | 3 (2) |
Other streptococci | 2 (1) | 0 | 2 (1) |
Miscellaneous | 1 (1) | 0 | 1 (1) |
Fungi | |||
Aspergillus fumigatus | 3 (2) | 0 | 3 (2) |
Cryptococcus neoformans | 1 (1) | 0 | 1 (1) |
Viruses | 0 | ||
Herpes simplex virus | 2 (1) | 0 | 2 (1) |
Cytomegalovirus | 1 (1) | 0 | 1 (1) |
Empirical Therapy | Patients n, (%) |
---|---|
Monotherapy | 49 (24) |
β-lactam antibiotic | 21 (10) |
Carbapenem | 16 (8) |
Fluoroquinolones | 3 (2) |
Other | 9 (4) |
Double combination | 72 (35) |
Carbapenem + polymyxin * | 23 (11) |
Carbapenem + oxazolidinone (Linezolid) | 13 (6) |
β-lactam antibiotic + fluoroquinolones | 8 (4) |
Carbapenem + glycopeptides | 5 (2) |
β-lactam antibiotic + aminoglycoside | 3 (2) |
Carbapenem + aminoglycoside | 2 (1) |
Carbapenem + fluoroquinolones | 1 (1) |
Other combinations | 17 (8) |
Triple-drug therapy | 86 (42) |
Carbapenem + aminoglycosides + polymyxin ** | 26 (13) |
Carbapenem + oxazolidinone (Linezolid) + polymyxin ** | 20 (10) |
Carbapenem + oxazolidinone (Linezolid) + fluoroquinolones | 5 (2) |
Miscellaneous | 35 (17) |
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Benítez-Cano, A.; Bermejo, S.; Luque, S.; Sorlí, L.; Carazo, J.; Zaragoza, I.; Ramos, I.; Vallès, J.; Horcajada, J.P.; Adalia, R. Clinical, Microbiological and Treatment Characteristics of Severe Postoperative Respiratory Infections: An Observational Cohort Study. J. Pers. Med. 2023, 13, 1482. https://doi.org/10.3390/jpm13101482
Benítez-Cano A, Bermejo S, Luque S, Sorlí L, Carazo J, Zaragoza I, Ramos I, Vallès J, Horcajada JP, Adalia R. Clinical, Microbiological and Treatment Characteristics of Severe Postoperative Respiratory Infections: An Observational Cohort Study. Journal of Personalized Medicine. 2023; 13(10):1482. https://doi.org/10.3390/jpm13101482
Chicago/Turabian StyleBenítez-Cano, Adela, Silvia Bermejo, Sonia Luque, Luisa Sorlí, Jesús Carazo, Irene Zaragoza, Isabel Ramos, Jordi Vallès, Juan P. Horcajada, and Ramón Adalia. 2023. "Clinical, Microbiological and Treatment Characteristics of Severe Postoperative Respiratory Infections: An Observational Cohort Study" Journal of Personalized Medicine 13, no. 10: 1482. https://doi.org/10.3390/jpm13101482