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J Am Coll Cardiol. 2014 Jul 29;64(4):372-81. doi: 10.1016/j.jacc.2014.04.052.

Management practices and major infections after cardiac surgery.

Author information

1
International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York. Electronic address: annetine.gelijns@mssm.edu.
2
International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York.
3
Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
4
Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
5
Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
6
Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
7
Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada.
8
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
9
Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
10
Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
11
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
12
Center for Heart & Vascular Health, Christiana Care Health System, Newark, Delaware.
13
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
14
Department of Medicine, Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa.
15
Department of Cardiovascular Sciences; East Carolina Heart Institute at East Carolina University, Greenville, North Carolina.
16
NIH Heart Center at Suburban Hospital, Bethesda, Maryland.
17
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

BACKGROUND:

Infections are the most common noncardiac complication after cardiac surgery, but their incidence across a broad range of operations, as well as the management factors that shape infection risk, remain unknown.

OBJECTIVES:

This study sought to prospectively examine the frequency of post-operative infections and associated mortality, and modifiable management practices predictive of infections within 65 days from cardiac surgery.

METHODS:

This study enrolled 5,158 patients and analyzed independently adjudicated infections using a competing risk model (with death as the competing event).

RESULTS:

Nearly 5% of patients experienced major infections. Baseline characteristics associated with increased infection risk included chronic lung disease (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.21 to 2.26), heart failure (HR: 1.47; 95% CI: 1.11 to 1.95), and longer surgery (HR: 1.31; 95% CI: 1.21 to 1.41). Practices associated with reduced infection risk included prophylaxis with second-generation cephalosporins (HR: 0.70; 95% CI: 0.52 to 0.94), whereas post-operative antibiotic duration >48 h (HR: 1.92; 95% CI: 1.28 to 2.88), stress hyperglycemia (HR: 1.32; 95% CI: 1.01 to 1.73); intubation time of 24 to 48 h (HR: 1.49; 95% CI: 1.04 to 2.14); and ventilation >48 h (HR: 2.45; 95% CI: 1.66 to 3.63) were associated with increased risk. HRs for infection were similar with either <24 h or <48 h of antibiotic prophylaxis. There was a significant but differential effect of transfusion by surgery type (excluding left ventricular assist device procedures/transplant) (HR: 1.13; 95% CI: 1.07 to 1.20). Major infections substantially increased mortality (HR: 10.02; 95% CI: 6.12 to 16.39).

CONCLUSIONS:

Major infections dramatically affect survival and readmissions. Second-generation cephalosporins were strongly associated with reduced major infection risk, but optimal duration of antibiotic prophylaxis requires further study. Given practice variations, considerable opportunities exist for improving outcomes and preventing readmissions. (Management Practices and Risk of Infection Following Cardiac Surgery; NCT01089712).

KEYWORDS:

cardiac surgery; infection; risk factors

PMID:
25060372
PMCID:
PMC4222509
DOI:
10.1016/j.jacc.2014.04.052
[Indexed for MEDLINE]
Free PMC Article

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