Department of Respiratory and Critical Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China.
Department of Cardiac Surgery, Beijing Anzhen Hospital Capital Medical University, Beijing, 100029, China.
BMC Cardiovasc Disord. 2023 Sep 21;23(1):472. doi: 10.1186/s12872-023-03488-1.
The prevalence of infections with multidrug-resistant organism (MDRO) pose great challenges for anti-infective therapy. Previous research on MDRO infections after cardiac surgery was limited. Therefore, understanding and mastering the clinical characteristics and risk predictors of MDRO infection after cardiac surgery is of great significance for standardized management of perioperative patients.
The medical records of adult patients with MDRO infection after cardiac surgery from January 2018 to October 2021 were collected, and patients were divided into MDR infection group (n = 176) and non-MDR infection group (n = 233). Univariate and multivariate regression analysis of variables was performed to determine the risk predictors of MDRO infection.
The incidence of MDRO infection was 8.6%. Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common, accounting for 37.3%, 23.5% and 18.0%, respectively. The main infection type were lower respiratory tract infection (LTRI = 29.0%). Univariate analysis showed that underwent coronary artery bypass graft (CABG) (P = 0.001) and secondary operation (P = 0.008), pre-infection exposure to vancomycin (P < 0.001) and linezolid (P = 0.002), combination antibiotics (P < 0.001), four antibiotics in combination (P = 0.005), glucocorticoid use (P = 0.029), preoperative hypoalbuminemia (P = 0.003) were risk factors for post-operative MDRO infection. Multivariate regression analysis showed that underwent CABG (OR = 1.228, 95%CI = 1.056∽1.427, P = 0.008), secondary operation (OR = 1.910, 95%CI = 1.131∽3.425, P = 0.015) and pre-infection exposure to linezolid (OR = 3.704, 95%CI = 1.291∽10.629, P = 0.005) were independent risk predictors for MDRO infection. The risk of MDRO infection increased with the length of stay in the ICU (P < 0.001) and the length of stay before diagnosis of infection (P = 0.003), and the difference was statistically significant. Meanwhile, the length of stay after infection (P = 0.005) and the total length of hospital stay (P < 0.001) were significantly longer in the MDRO infection group, and the all-cause mortality was numerically higher in the MDRO infection group (31.3% versus 23.2%).
The morbidity and mortality of MDRO infection was high in adult cardiac surgery, and many risk factors influence the occurrence of MDRO infection. In the future, clinicians should focus on high-risk patients, strengthen multidisciplinary collaboration on infection prevention and control measures, reduce the morbidity and mortality of MDRO infection, and improve the prognosis of in-hospital patients.
多重耐药菌（MDRO）感染的流行对抗感染治疗构成了巨大挑战。之前关于心脏手术后 MDRO 感染的研究有限。因此，了解和掌握心脏手术后 MDRO 感染的临床特征和风险预测因素，对于规范围手术期患者管理具有重要意义。
收集了 2018 年 1 月至 2021 年 10 月期间成人心脏手术后 MDRO 感染患者的病历，并将患者分为 MDR 感染组（n=176）和非 MDR 感染组（n=233）。对变量进行单因素和多因素回归分析，以确定 MDRO 感染的风险预测因素。
MDRO 感染的发生率为 8.6%。鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌最常见，分别占 37.3%、23.5%和 18.0%。主要感染类型为下呼吸道感染（LTRI=29.0%）。单因素分析显示，行冠状动脉旁路移植术（CABG）（P=0.001）和二次手术（P=0.008）、感染前接触万古霉素（P<0.001）和利奈唑胺（P=0.002）、联合使用抗生素（P<0.001）、四联抗生素（P=0.005）、使用糖皮质激素（P=0.029）、术前低白蛋白血症（P=0.003）是术后 MDRO 感染的危险因素。多因素回归分析显示，行 CABG（OR=1.228，95%CI=1.056∽1.427，P=0.008）、二次手术（OR=1.910，95%CI=1.131∽3.425，P=0.015）和感染前接触利奈唑胺（OR=3.704，95%CI=1.291∽10.629，P=0.005）是 MDRO 感染的独立危险因素。MDRO 感染的风险随着 ICU 住院时间（P<0.001）和感染前诊断时间（P=0.003）的延长而增加，差异具有统计学意义。同时，MDRO 感染组的感染后住院时间（P=0.005）和总住院时间（P<0.001）明显延长，MDRO 感染组的全因病死率呈数值增高趋势（31.3%比 23.2%）。
成人心脏手术后 MDRO 感染的发病率和死亡率较高，许多危险因素影响 MDRO 感染的发生。未来，临床医生应关注高危患者，加强感染防控措施的多学科合作，降低 MDRO 感染的发病率和死亡率，改善住院患者的预后。
