Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília

Abstract

Objective this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília. Results 351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08), use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99). Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24). Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0), insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2). Conclusion Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.

Perfil clínico-cirúrgico de pacientes com mediastinite pós-cirurgia cardíaca: estudo transversal retrospectivo

“…Um estudo demonstrou que cada semana de internação hospitalar no pré-operatório aumenta em 15% o risco de mediastinite, associado ao prolongamento do jejum pré-operatório, que compromete a nutrição adequada e a recuperação pós-operatória dos pacientes 14 . Ademais, eleva o risco de desenvolvimento de complicações infecciosas, entre elas as infecções do sítio cirúrgico, a admissão em UTI e o uso de dispositivos invasivos (cateter venoso central, sonda vesical de demora e ventilação mecânica), que tornam o paciente suscetível a infecções ligadas à assistência à saúde 15 .…”

Clinical‐care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital

“…After the implementation of the CCPPM occurred an expressive reduction of mediastinitis to 0.09% (virtually null). The findings of the post‐CCPPM period cannot be attributed to the higher prevalence of comorbidities or severity of patients since there was no significant difference in the prevalence of T2DM, glucose control, renal function, or LVEF comparing with a post‐CCPPM period. Also, a multivariable validated model to predict surgical risk from STS was similar in both groups reinforcing the similarities between the two groups.…”

“…14,15 After the implementation of the CCPPM occurred an expressive reduction of mediastinitis to 0.09% (virtually null). The findings of the post-CCPPM period cannot be attributed to the higher prevalence of comorbidities 16…”

Indwelling urinary catheter use and associated outcomes among adult patients undergoing surgery

“…The most of studies 6 (54.5%) were conducted in the United States of America, one in India, one in Sweden, one in Tarnow, Poland, one in Brazil, and one in the Netherlands (tables 1,2,3). Three articles assessed the incidence of IUC use, [27][28][29] four articles talked about the appropriateness of IUCs in terms of timing, duration and need of IUCs based on individual bladder capacity [29][30][31] The review found that IUCs are mostly used for patients undergoing major operations. The incidence range of IUCs placement was between 86% and 87.3% among patients undergoing surgery.…”

“…The incidence range of IUCs placement was between 86% and 87.3% among patients undergoing surgery. [8,28] The incidence was variable depending on the type of surgery. It was 26.9% in genitor-urinary surgeries, [35] 38% in the orthopaedic surgeries, 28% in cardiac surgeries, 22% for GI surgeries, 21.7% in gynaecology, 20.4% in general surgery and 12% in vascular surgery.…”