1
ELECTRONIC SUPPLEMENT TO
Pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk
patients
Authors
Emilio Bouza MD PhD1,2,4,5 (ebouza@microb.net)
María Jesús Pérez Granda RN2,3 (massus@hotmail.es)
Javier Hortal MD PhD2,3 (javier.hortal@gmail.com)
José M Barrio MD2,3 (jmbarriogut@gmail.com)
Emilia Cercenado PharmD1,2,4,5 (ecercenado.hgugm@salud.madrid.org)
Patricia Muñoz MD PhD1,2,4,5 (pmunoz@micro.hggm.es)
1
Department of Clinical Microbiology and Infectious Diseases.2Ciber de Enfermedades
Respiratorias (CIBERES) and 3Department of Anesthesiology, Hospital General Universitario
Gregorio Marañón, 4Department of Medicine, Universidad Complutense, Madrid, Spain, 5Red
Española de Investigación en Patología Infecciosa (REIPI)
2
RESULTS
Pre-surgery information in both populations
The underlying conditions and surgical variables of both populations are compared in Table
1. Sex, comorbidity, underlying conditions, NYHA functional score, ASA score, and EuroSCORE
(7.55 ± 2.9 in the control group vs 7.18 ± 3 in intervention group: p= 0.57) were comparable in both
groups. Patients in the control group were older, underwent more CABG procedures and required
more inotropes (Table 1).
Data on the surgical procedure
Type of surgery, time on cardiopulmonary by-pass, aortic cross-clamp time, transfusion
needs, re-interventions, antimicrobial prophylaxis, and need for inotropic support were similar in
both groups (Table 1). The mean APACHE II score immediately after surgery (at admission to the
MHS-ICU) was 10.3 (±2.7) for the control group and 9.5 (±2.5) for the intervention group (P=0.2).
Patients requiring mechanical ventilation >7 days (18 control group and 19 intervention group) and
days in the ICU free of mechanical ventilation [median of 3 (1-7.2) in the control group vs 3 (0-5.7)
in the intervention group] were equally distributed.
3
Figure 1. Selection of patients for the study
1250
MHS
234
MV> 48 H
34 previous antimicrobials
59 deaths before inclusion
24 heart transplantation
22 refused consent
17 another study
156
Excluded
78
40
Intervention
Group
MHS: total patients undergoing major heart surgery
MV: patients under mechanical ventilation
38
Control
Group
4
Figure 2. Etiology of VAP and tracheobronchitis. Each patient is represented by a square.
INTERVENTION GROUP
Staphylococcus aureus
Enterobacteriaceae
Pseudomonas aeruginosa
Haemophilus influenzae
Stenotrophomonas maltophilia
Acinetobacter spp.
CONTROL GROUP