Blood stream infection in patients undergoing systematic off-pump coronary artery bypass: Incidence, risk factors, outcome, and associated pathogens
Journal
Surgical Infections
Journal Volume
15
Journal Issue
5
Pages
613-618
Date Issued
2014
Author(s)
Abstract
Background: Blood stream infection (BSI) is a major cause of mortality and morbidity for patients undergoing cardiac surgery. However, information is lacking about patients undergoing off-pump coronary artery bypass (OPCAB). The purpose of this study was to assess the incidence, risk factors, outcome and associated pathogens of BSI after OPCAB.
Methods: One thousand ten consecutive patients undergoing OPCAB between 2001 and 2012 were included in a retrospective case-control study. A propensity-matched control was used for risk factor analysis.
Results: Of the 1,010 patients, 26 patients (2.6%) had 32 episodes of BSI after surgery, which occurred at a median of 14 d after surgery. Gram-negative bacilli and gram-positive cocci were distributed equally. Methicillin-resistant Staphylococcus aureus was the pathogen identified most frequently, and the most common source of infection was a surgical site. The hospital mortality rate was 54%. By univariable analysis, diabetes mellitus, pre-operative renal impairment, pre-operative low hemoglobin, pre-operative endotracheal intubation, dialysis before or after surgery, cardiogenic shock, left ventricular ejection fraction of less than 40%, non-elective surgery, low number of distal anastomoses, atrial fibrillation after surgery, and re-operation for bleeding were significant risk factors. By multivariable analysis, the independent risk factors were left ventricular ejection fraction of less than 40%, low number of distal anastomoses, atrial fibrillation after surgery, and dialysis after surgery.
Conclusions: Blood stream infections remained a common complication after OPCAB, and the mortality was high. Gram-negative bacilli and gram-positive cocci were distributed equally. Methicillin-resistant S. aureus was the pathogen identified most frequently. Preventive tactics should target likely pathogens and high-risk patients undergoing OPCAB.
SDGs
Other Subjects
cefazolin; hemoglobin; adult; aged; anastomosis; antibiotic prophylaxis; Article; bleeding; bloodstream infection; cardiogenic shock; case control study; controlled study; coronary artery disease; diabetes mellitus; dialysis; elective surgery; endotracheal intubation; female; Gram negative bacterium; Gram positive cocci; heart atrium fibrillation; heart left ventricle ejection fraction; human; incidence; kidney dysfunction; major clinical study; male; methicillin resistant Staphylococcus aureus; mortality; off pump coronary surgery; preoperative period; reoperation; retrospective study; risk factor; surgical infection; treatment outcome; adverse effects; bacteremia; bacterium; classification; isolation and purification; microbiology; middle aged; off pump coronary surgery; very elderly; Adult; Aged; Aged, 80 and over; Bacteremia; Bacteria; Coronary Artery Bypass, Off-Pump; Female; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome
Publisher
Mary Ann Liebert Inc.
Type
journal article