Schaeffer Thibault, Kuster Sabine, Koechlin Luca, Khanna Nina, Eckstein Friedrich S, Reuthebuch Oliver
Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland.
Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, 4031 Basel, Switzerland.
J Clin Med. 2023 Jan 26;12(3):948. doi: 10.3390/jcm12030948.
Disseminated (. ) infection following cardiac surgery has been associated with a high mortality. The long-term impact of surgery and the appropriate surgical approach are still matters of debate.
From 2015 to 2019, seven patients with infection following cardiac surgery were isolated.
The median incubation time was 30 months (IQR 18-38). Echocardiography was unremarkable in three patients (43%). We decided to redo cardiac surgery in all patients and explanted all previously implanted prosthetic material. All explant cultures yielded One patient (14%) died in-hospital seven months after the redo surgery. After a median follow-up of 59.6 months (IQR 39.1-69.6), we observed three infection relapses among the survivors (43%), presumably due to concomitant extracardiac infection and recurrent cardiac implant infection.
infection following cardiac surgery is associated with a delayed and unspecific clinical presentation. Echocardiogaphy has a limited sensitivity for prosthetic valve infection with , and negative findings should not preclude the surgical decision. The extraction of all previously implanted material is crucial to achieving the source control, as the re-implantation of prosthetic material as well as uncontrolled extracardiac infection at the time of the redo cardiac surgery appear to be key factors for persisting/relapsing infection.
心脏手术后播散性（.）感染与高死亡率相关。手术的长期影响以及合适的手术方式仍存在争议。
2015年至2019年，分离出7例心脏手术后发生感染的患者。
中位潜伏期为30个月（四分位间距18 - 38个月）。3例患者（43%）超声心动图检查无异常。我们决定对所有患者再次进行心脏手术，并取出所有先前植入的假体材料。所有取出物培养均发现 1例患者（14%）在再次手术后7个月死于医院。中位随访59.6个月（四分位间距39.1 - 69.6个月）后，我们观察到幸存者中有3例感染复发（43%），可能是由于合并心外感染和心脏植入物反复感染。
心脏手术后感染与延迟且非特异性的临床表现相关。超声心动图对假体瓣膜感染的敏感性有限，阴性结果不应排除手术决策。取出所有先前植入的材料对于实现源头控制至关重要，因为再次心脏手术时假体材料的重新植入以及未控制的心外感染似乎是感染持续/复发的关键因素。
