Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study

Abstract

BackgroundThe management of hospital-acquired infections (HAIs) with respect to physician practices remains largely unexplored despite increasing efforts to standardize care. In the present study, we report findings from a 2-month audit of all patients that have undergone cardiac surgery at a large referral center in Atlantic Canada.MethodsAll patients who underwent cardiac surgical procedures during May and June 2013 at the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia were identified. The prevalence of urinary tract infections (UTIs), pneumonia, leg harvest site infections, superficial sternal wound infections, deep sternal wound infections, and sepsis was examined to determine physician approaches in terms of verification rates (microbiology), time of diagnosis and duration of treatment. Continuous variables were compared using Student’s t-test and categorical variables were analyzed using Fischer’s exact test.ResultsA total of 185 consecutive patients underwent cardiac surgical procedures, of which 39 (21%) developed at least one postoperative infection. The overall prevalence of infection types, from highest to lowest, was UTI (8%), pneumonia (7%), leg harvest site infection (5%), superficial surgical site infection (4%), and sepsis (2%). There were no deep sternal wound infections. The overall in-hospital mortality rate was 3.8% with a median length of stay (LOS) of 8 days. The overall infection verification rate was 50% (ranged from 100% in sepsis to 10% in leg harvest site infections). In all cases, a full course of antibiotics was administered despite negative microbiology cultures or limited evidence of an actual infection.ConclusionsHAIs are commonly treated without being verified and treatment is often not discontinued after negative cultures are received. Our findings highlight the fact that antibiotic treatment is not always supported by evidence, and the effect of this could contribute to increased selective pressure for antimicrobial resistant bacteria.

Healthcare-Associated Infections in a Cardiac Surgery Service in Brazil

“…Cardiovascular surgery is generally considered a clean surgery, once the respiratory, digestive, and urinary tract are not involved during the surgical procedure and there is rarely a local infectious process [ 1 , 11 ] . Different studies have shown that HAI rates can range from 6% to 24%, depending on the characteristics of the services and patients, while the HAI rate in the cardiovascular surgery service of HC-UFPR is 22.6% [ 3 , 6 , 7 , 12 ] . Although within the expected percentage, HAI in our service is close to the upper limit of normality.…”

“…There was a difference between the mean age of the groups, and the group without infection had a mean age of 59.5 years, while the group with infection had a mean age of 64.5 years. Studies have shown that older patients are more likely to develop infectious processes during surgical procedures [ 7 , 12 ] . Two factors can explain this phenomenon.…”

“…Although cardiovascular surgery represents a type of operation with low infectious rate, infectious processes are usually among the main complications described [ 4 - 6 ] . The rates of HAI in cardiac surgery vary between 6 and 24% [ 3 , 6 , 7 ] . Pneumonia, surgical site, and urinary tract are the most common sites of infection [ 3 ] .…”

“…Pneumonia, surgical site, and urinary tract are the most common sites of infection [ 3 ] . The age and gender of patients, the presence of comorbidities and the type of procedure performed seem to be risk factors for the development of infections [ 7 - 9 ] . The LOS of individuals who develop HAI is significantly increased compared to those without infection [ 6 , 7 ] .…”

“…The age and gender of patients, the presence of comorbidities and the type of procedure performed seem to be risk factors for the development of infections [ 7 - 9 ] . The LOS of individuals who develop HAI is significantly increased compared to those without infection [ 6 , 7 ] . This excess of time that the patient remains in the hospital environment generates negative impacts for both the user and the health system as a whole, with gradually higher costs [ 10 ] .…”