Effect of preoperative pneumococcal immunization on the incidence of respiratory infection in the postoperative period of cardiac surgery
Keywords:Pneumonia; Thoracic Surgery; Pneumococcal Pneumonia; Immunization; Pneumococcal vaccines.
Objective: To analyze whether the incidence of respiratory infections in the postoperative period of cardiac surgery is lower in patients immunized with the 13-valent pneumococcal conjugate vaccine. To study the main risk factors related to the development of infections in patients undergoing cardiac surgery. Methodology: 40 patients were included in the study, randomized 1: 1 to receive pneumococcal vaccine or placebo, 14 days before undergoing elective cardiac surgery. The incidence of infections in the 30 postoperative days was compared between groups. Results: There were 6 respiratory infections in the vaccine group and 2 in the placebo group (p=0.2024) and one death in the placebo group and none in the vaccine group (p=0.3173). Chronic obstructive pulmonary disease (p=0.003), diabetes mellitus (p=0.047) and peripheral arterial disease (p=0.0001) were listed as risk factors for the development of infections, which generated an increase in hospital stay (95% CI : 1.33- 7.13; p =0.0147) and ICU stay in the postoperative period (95% CI: 1.87- 33.45; p=0.0025). Conclusion: The application of pneumococcal vaccine 13v did not influence the development of postoperative pulmonary infections. Chronic obstructive pulmonary disease, diabetes mellitus and peripheral arterial disease were identified as risk factors for the development of infections, increasing the length of total hospital stay and time in the ICU.
Ailawadi, G., Chang, H. L., Gara, P. T. O., Karen, O., Woo, Y. J., Jr, J. J. D., Parides, M. K., Vinod, H., Robichaud, S., Gillinov, A. M., Taddei-peters, W. C., Miller, M. A., Perrault, L. P., Smith, R. L., Horvath, K. A., Doud, K., Baio, K., & Annetine, C. (2017). Pneumonia After Cardiac Surgery: Experience of the NIH/CIHR Cardiothoracic Surgical Trials Network. J Thorac Cardiovasc Surg, 153(6), 1384–1391.
Bonten, M. J. M., Huijts, S. M., Bolkenbaas, M., Webber, C., Patterson, S., Gault, S., van Werkhoven, C. H., van Deursen, A. M. M., Sanders, E. A. M., Verheij, T. J. M., Patton, M., McDonough, A., Moradoghli-Haftvani, A., Smith, H., Mellelieu, T., Pride, M. W., Crowther, G., Schmoele-Thoma, B., Scott, D. A., … Grobbee, D. E. (2015). Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults. New England Journal of Medicine, 372(12), 1114–1125.
Damavandi, D. S., Javan, M., Moshashaei, H., Forootan, M., & Darvishi, M. (2020). Microbial Contamination after Cardiac Surgery in a Hospital Cardiac Surgery Ward. Journal of Medicine and Life, 13(3), 342–348.
Dordetto, P. R., Pinto, G. C., & Rosa, T. C. S. de C. (2016). Pacientes submetidos à cirurgia cardíaca: caracterização sociodemográfica, perfil clínico‑epidemiológico e complicações. Revista Da Faculdade de Ciências Médicas de Sorocaba, 18(3), 144–149.
Figueira Gonçalves, J. M., García Bello, M. A., Bethencourt Martín, N., Díaz Pérez, D., & Pérez-Méndez, L. I. (2019). Impact of 13-valent pneumococcal conjugate polysaccharide vaccination on severe exacerbations in patients with chronic obstructive pulmonary disease and established cardiovascular disease. European Journal of Internal Medicine, 63(February), e14–e16.
Lanks, C. W., Musani, A. I., & Hsia, D. W. (2019). Community-acquired Pneumonia and Hospital-acquired Pneumonia. Medical Clinics of North America, 103(3), 487–501.
Lentsck, M. H., Latorre, M. do R. D. de O., & Mathias, T. A. de F. (2015). Tendência das internações por doenças cardiovasculares sensíveis à atenção primária. Revista Brasileira de Epidemiologia, 18(2), 372–384.
Ministério da Saúde Brasil (2019). Departamento de Informática do SUS – DATASUS. Informações de Saúde, Mortalidade Geral. http://www2.datasus.gov.br/DATASUS/index.php?area=0205&id=6937&VObj=http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/obt10
Nashef, S. A. M., Roques, F., Sharples, L. D., Nilsson, J., Smith, C., Goldstone, A. R., & Lockowandt, U. (2012). Euroscore II. European Journal of Cardio-Thoracic Surgery, 41(4), 734–745.
Ortiz, L. D. N., Schaan, C. W., Leguisamo, C. P., Tremarin, K., Mattos, W. L. L. D., Kalil, R. A. K., & Pellanda, L. C. (2010). Incidence of pulmonary complications in myocardial revascularization. Arquivos Brasileiros de Cardiologia, 95(4), 441–446.
Pereira A.S. et al. (2018). Metodologia da pesquisa científica . UFSM. https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia - Pesquisa -Cientifica.pdf?sequence=1
Sarmiento, E., Rodríguez-Hernández, C., Rodríguez-Molina, J., Fernández-Yánez, J., Palomo, J., Anguita, J., Pérez, J. L., Lanio, N., Fernández-Cruz, E., & Carbone, J. (2006). Impaired anti-pneumococcal polysaccharide antibody production and invasive pneumococcal infection following heart transplantation. International Immunopharmacology, 6(13–14), 2027–2030.
Strobel, R. J., Harrington, S. D., Hill, C., Thompson, M. P., Cabrera, L., Theurer, P., Wilton, P., Gandhi, D., Delucia Iii, A., Paone, G., Wu, X., Zhang, M., Krein, S. L., Prager, R. L., & Likosky, D. S. (n.d.). Evaluating The Impact of Pneumonia Prevention Recommendations Following Cardiac Surgery on behalf of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, 110(3), 903–910.
SBIM – Sociedade Brasileira de Imunizações (2020). Doença Pneumocócica. https://familia.sbim.org.br/doencas/doenca-pneumococica-dp
Sheng, W., Xing, Q. S., Hou, W. M., Sun, L., Niu, Z. Z., Lin, M. S., & Chi, Y. F. (2014). Independent risk factors for ventilator-associated pneumonia after cardiac surgery. Journal of Investigative Surgery, 27(5), 256–261.
Topal, A. E., & Eren, M. N. (2012). Risk factors for the development of pneumonia post cardiac surgery. Cardiovascular Journal of Africa, 23(4), 212–215.
Vera Urquiza, R., Bucio Reta, E. R., Berríos Bárcenas, E. A., & Choreño Machain, T. (2016). Factores de riesgo para desarrollar neumonía postquirúrgica en pacientes operados de cirugía cardiaca. Archivos de Cardiologia de Mexico, 86(3), 203–207.
How to Cite
Copyright (c) 2021 Stéfani Galli; Mário Augusto Cray da Costa; Ana Carolina Mello Fontoura de Souza; Dionizia Xavier Scomparin
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.