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Am J Infect Control. 2012 Dec;40(10):963-8. doi: 10.1016/j.ajic.2012.01.012. Epub 2012 May 19.

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

Author information

1
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. chen@duke.edu

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.

PMID:
22609237
PMCID:
PMC3535474
DOI:
10.1016/j.ajic.2012.01.012
[Indexed for MEDLINE]
Free PMC Article
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