Microbiology of post-operative pulmonary infections after thoracoabdominal aortic aneurysm repair.
CCCF ePoster library. Randall I. Oct 2, 2017; 198154; 3 Disclosure(s): None
Dr. Ian Randall
Dr. Ian Randall
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Abstract
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Microbiology of post-operative pulmonary infections after thoracoabdominal aortic aneurysm repair.

Randall, Ian1, Ouzounian, Maral2, Wijeysundera, Duminda N.3



1Department of Anesthesia, Toronto General Hospital, Toronto, Canada 

2Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada

3Department of Anesthesia, Toronto General Hospital, Toronto, Canada


Introduction
Postoperative pulmonary complications occur in up to 50% of patients after surgical repair of thoracoabdominal aortic aneurysms (TAAA). Early and repeated bronchoscopy is often necessary for pulmonary toilet in the postoperative phase, and early onset of pneumonia (≤7 days after surgery) is common. Clinical observations suggest a preponderance of gram-negative organisms in microbiological samples drawn during this early period. 
Objective
This retrospective cohort study sought to characterize the frequency and underlying microbiology of postoperative pulmonary infections.
Methods 
We conducted a single-center, retrospective cohort study of TAAA repairs performed by a single surgeon between 2013 and 2016. Information pertaining to eligible patients’ demographics, comorbidities, Crawford classification other surgical characteristics, microbiology, antibiotic use, and outcomes, including duration of ventilation, mortality, intensive care unit (ICU) and hospital length of stay (LOS), were abstracted from their medical records.
Results
The cohort included 27 patients who underwent 28 TAAA repair surgeries. The mean age was 55.4 years (IQR 51y and 64y) and 19 (70.3%) were male. With respect to comorbid disease, 8 patients had cardiac disease and 10 had Marfan’s syndrome or other connective tissue disorders. Of the procedures, 9 were urgent or emergent repairs, 19 were Crawford Types 1 or 2 repairs and 9 were Types 3, 4, or 5 repairs.  Three patients died, including 1 from ARDS leading to multi-organ failure. Ten (37%) had pneumonia requiring antibiotics within 7 days after surgery. In all 8 cases with positive cultures, gram negative species were the predominant microbe. The median ICU LOS was 25.5 days among individuals with pneumonia versus 7 days for those without (p=0.02).
Conclusion 
This cohort study provides new data on the frequency of early pulmonary infections and their concomitant microbiology in this postoperative population. Gram negative species predominate despite the early post-operative timing. These data may provide insights into new approaches for perioperative antimicrobial prophylaxis, such as broadening of antibiotic coverage, selective digestive tract decontamination, or probiotic administration.

 

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