Epidemiology and outcome of major postoperative infections following cardiac surgery: Risk factors and impact of pathogen type

Abstract

Background Major postoperative infections (MPIs) are poorly understood complications of cardiac surgery. We examined the epidemiology, microbiology, and outcome of MPIs occurring after cardiac surgery. Methods The study cohort was drawn from the Society of Thoracic Surgeon National Cardiac Database and comprised adults who underwent cardiac surgery at 5 tertiary hospitals between 2000 and 2004. We studied the incidence, microbiology, and risk factors of MPI (bloodstream or chest wound infections within 30 days after surgery), as well as 30-day mortality. We used multivariate regression analyses to evaluate the risk of MPI and mortality. Results MPI was identified in 341 of 10,522 patients (3.2%). Staphylococci were found in 52.5% of these patients, gram-negative bacilli (GNB) in 24.3%, and other pathogens in 23.2%. High body mass index, previous coronary bypass surgery, emergency surgery, renal impairment, immunosuppression, cardiac failure, and peripheral/cerebrovascular disease were associated with the development of MPI. Median postoperative duration of hospitalization (15 days vs 6 days) and mortality (8.5% vs 2.2%) were higher in patients with MPIs. Compared with uninfected individuals, odds of mortality were higher in patients with S aureus MPIs (adjusted odds ratio, 3.7) and GNB MPIs (adjusted odds ratio, 3.0). Conclusions Staphylococci accounted for the majority of MPIs after cardiac surgery. Mortality was higher in patients with Staphylococcus aureus- and GNB-related MPIs than in patients with MPIs caused by other pathogens and uninfected patients. Preventive strategies should target likely pathogens and high-risk patients undergoing cardiac surgery.

Bacterial epidemiology of post-operative infections at a cardiac center

“…The infection rates vary from 3.5% in superficial wounds to 1% in deep sternal wound. [1][2][3][4][5] In the present study the rate of infection is concurrent with other study groups.…”

“…High body mass index, prolonged surgery, antibiotic prophylaxis, prolonged length of hospital stay, multiple blood transfusions, reoperation and many other factors were proven to contribute to the infection risk. [1][2][3]5,[13][14][15] Attention to these issues could result in a decrease in the infection rates. Good patient preparation, aseptic technique, appropriate antibiotic prophylaxis may help in better outcomes.…”

“…The rate varies between 1.8% upto 4.7%. [1][2][3][4][5] The diagnosis is often difficult to make so a correlation between clinical and microbiological findings should be taken into consideration. 6 This is a prospective study and based on laboratory data collected from microbiology laboratory, and/or infection control data and includes the type of bacterial isolate, type of surgery or the procedure during a two year period at a cardiac center in Eastern Province, Saudi Arabia.…”

High-Dose Continuous Oxacillin Infusion Results in Achievement of Pharmacokinetics Targets in Critically Ill Patients with Deep Sternal Wound Infections following Cardiac Surgery

“…Firstline therapy is associated with surgical debridement and antimicrobial therapy. Staphylococcus species were the primary causative organisms found in several cohort studies (2,3,5,6). When the staphylococci are methicillin sensitive, ␤-lactams are the drugs of choice, in association with an aminoglycoside.…”

“…eep sternal wound infections (DSWI) following cardiac surgery, also called poststernotomy mediastinitis, are associated with significantly lengthened hospital stays and increased morbidity and mortality and, therefore, additional expenses (1)(2)(3)(4). Firstline therapy is associated with surgical debridement and antimicrobial therapy.…”