Department of Anaesthesiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Department of Anaesthesiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain.
J Clin Anesth. 2021 May;69:110104. doi: 10.1016/j.jclinane.2020.110104. Epub 2020 Nov 19.
To determine the rate of nosocomial infection among patients undergoing cardiac surgery and to identify risk factors and the impact of these infections on patient mortality.
Prospective observational study.
Intensive Care Unit (ICU).
1097 adult patients who underwent cardiac surgery at Hospital Clínico Universitario de Valladolid between January 2011 and January 2016.
None.
Preoperative, intraoperative and postoperative medical, surgical and anaesthetic variables.
A total of 111 patients (10.1%) acquired a nosocomial infection in the postoperative period. Pneumonia was the most frequent (4.2%) nosocomial infection. Three independent risk factors for the development of a nosocomial infection were identified: cardiopulmonary bypass time, kidney failure and emergency surgery. The stay in the ICU was significantly higher in patients who developed a nosocomial infection (16.6 ± 38.8 vs. 4.4 ± 17.8, P < 0.001). The mortality rate of patients who acquired a nosocomial infection was significantly greater (18%) than that of patients who did not acquire a nosocomial infection (5%) (P < 0.001). The 90-day survival was greater in the group of patients without nosocomial infection (log rank 27.55, P < 0.001). The dynamic modelling of 90-day mortality revealed that in the first week, cardiopulmonary bypass time (HR = 1.00, 95% CI 1.00-1.02, P < 0.001) and emergency surgery (HR = 0.12, 95% CI 0.04-0.37, P < 0.001) were the most important risk factors for mortality, while after the first week, nosocomial infection (HR = 6.23, 95% CI 2.49-15.63, P < 0.001) was the main risk factor, followed by cardiopulmonary bypass time (HR = 1.01, 95% CI 1.00-1.01, P = 0.001) and EuroSCORE (HR = 1.03, 95% CI 1.00-1.06, P = 0.008).
Nosocomial infections after cardiac surgery constitute the main independent risk factor for mortality after the first week of surgery. These data suggest that its prevention following cardiac surgery must be prioritised to improve patient outcomes.
确定心脏手术后患者的医院感染率，并确定这些感染对患者死亡率的影响因素。
前瞻性观察性研究。
重症监护病房（ICU）。
2011 年 1 月至 2016 年 1 月期间在瓦拉多利德临床大学医院接受心脏手术的 1097 名成年患者。
无。
术前、术中及术后的医疗、手术和麻醉变量。
共有 111 名患者（10.1%）在术后期间发生医院感染。肺炎是最常见的（4.2%）医院感染。有三个独立的危险因素与医院感染的发展有关：体外循环时间、肾功能衰竭和急诊手术。发生医院感染的患者 ICU 停留时间明显较长（16.6±38.8 与 4.4±17.8，P<0.001）。发生医院感染的患者死亡率（18%）明显高于未发生医院感染的患者（5%）（P<0.001）。未发生医院感染的患者 90 天生存率明显较高（对数秩检验 27.55，P<0.001）。90 天死亡率的动态模型显示，在第一周内，体外循环时间（HR=1.00，95%置信区间 1.00-1.02，P<0.001）和急诊手术（HR=0.12，95%置信区间 0.04-0.37，P<0.001）是死亡的最重要危险因素，而在第一周后，医院感染（HR=6.23，95%置信区间 2.49-15.63，P<0.001）是主要的危险因素，其次是体外循环时间（HR=1.01，95%置信区间 1.00-1.01，P=0.001）和 EuroSCORE（HR=1.03，95%置信区间 1.00-1.06，P=0.008）。
心脏手术后的医院感染是手术后第一周后患者死亡的主要独立危险因素。这些数据表明，必须优先预防心脏手术后的医院感染，以改善患者的预后。
