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Taušan Ð, Rančić N, Kostić Z, Ljubenović N, Rakonjac B, Šuljagić V. An assessment of burden of hospital-acquired pneumonia among abdominal surgical patients in tertiary university hospital in Serbia: A matched nested case-control study. Front Med (Lausanne) 2022; 9:1040654. [PMID: 36569168 PMCID: PMC9780448 DOI: 10.3389/fmed.2022.1040654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background In the population of abdominal surgical patients hospital-acquired pneumonia (HAP) significantly increases morbidity and mortality. Patients and methods Through regular hospital surveillance of patients who received abdominal operations, we identified postoperative HAP from 2007 to 2019. In an initial nested case-control study, every surgical patient with HAP was compared with three control patients without HAP. Control patients were matched to the cases by age, gender, the American Society of Anesthesiologists score, and type of surgical operation. Also, the patients with HAP, who died were compared with those who survived. Results Multivariate logistic regression analysis (MLRA) revealed that other postoperative infections, length of intensive care unit stay, use of H2RA, use of PPI/ H2RA, multiple transfusion, and use of vancomycin in surgical prophylaxis were independent RFs for occurrence of HAP. Also, MLRA identified that age, lenght of hospital stay, use of mechanical ventilation and ceftriaxone in HAP therapy were indepedenttly associated with poor outcome of HAP. All Acinetobacter baumannii isolates were resistant to aminoglycoside antimicrobial agents and showed carbapenem resistance. The most frequently used antibiotics in patients with HAP and without HAP were vancomycin and metronidazole, respectively. Conclusion Our study provided an insight into the burden of HAP in abdominal surgical patients, and highlighted several priority areas and targets for quality improvement.
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Affiliation(s)
- Ðorde Taušan
- Pulmonology Clinic, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Rančić
- Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia,Medical Faculty, University of Defence, Belgrade, Serbia
| | - Zoran Kostić
- Medical Faculty, University of Defence, Belgrade, Serbia,Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
| | - Nenad Ljubenović
- Institute of Epidemiology, Military Medical Academy, Belgrade, Serbia
| | - Bojan Rakonjac
- Institute of Medical Microbiology, Military Medical Academy, Belgrade, Serbia
| | - Vesna Šuljagić
- Medical Faculty, University of Defence, Belgrade, Serbia,Department of Healthcare-Associated Infection Prevention and Control, Military Medical Academy, Belgrade, Serbia,*Correspondence: Vesna Šuljagić
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Kawasaki K, Yamamoto M, Suka Y, Kawasaki Y, Ito K, Koike D, Furuya T, Nagai M, Nomura Y, Tanaka N, Kawaguchi Y. Development and validation of a nomogram predicting postoperative pneumonia after major abdominal surgery. Surg Today 2019; 49:769-777. [PMID: 30919124 DOI: 10.1007/s00595-019-01796-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/07/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Postoperative pneumonia (POP) is a common complication that can adversely affect the outcomes after surgery. This study aimed to devise and validate a model for stratifying the probability of POP in patients undergoing abdominal surgery. METHODS We included 1050 patients who underwent major abdominal surgery between 2012 and 2013. A nomogram was devised by evaluating the predictive factors for POP. RESULTS Of the 1050 patients, 56 (5.3%) developed POP. Multivariable logistic regression analysis revealed that the independent predictive factors for POP were age, male sex, history of cerebrovascular disease, Brinkman Index (BI) ≥ 900, and upper midline incision. A nomogram was devised by employing these five significant predictive factors. The prediction model showed a relatively good discrimination performance, with a concordance index of 0.77. CONCLUSIONS A nomogram based on age, male sex, history of cerebrovascular disease, BI ≥ 900, and upper midline incision may be useful for identifying patients with a high probability of developing POP after major abdominal surgery.
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Affiliation(s)
- Keishi Kawasaki
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan.,Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-0856, Japan
| | - Mariko Yamamoto
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Yusuke Suka
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Kyoji Ito
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan.,Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daisuke Koike
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Takatoshi Furuya
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Motoki Nagai
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Yukihiro Nomura
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan
| | - Nobutaka Tanaka
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan.
| | - Yoshikuni Kawaguchi
- Department of Surgery, Asahi General Hospital, 1326 I, Asahi, Chiba, 289-2511, Japan. .,Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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