Erdem Hakan, Ankarali Handan, Al-Tawfiq Jaffar A, Angamuthu Kumar, Piljic Dragan, Umihanic Ajdin, Dayyab Farouq, Karamanlioğlu Dilek, Pekok Abdullah Umut, Cagla-Sonmezer Meliha, El-Kholy Amani, Gad Maha Ali, Velicki Lazar, Akyildiz Ozay, Altindis Mustafa, Başkol-Elik Dilşah, Erturk-Sengel Buket, Kara İbrahim, Kahraman Umit, Özdemir Mehmet, Caskurlu Hulya, Cag Yasemin, Al-Khalifa Abdulwahab, Hakamifard Atousa, Batinjan Marina Kljaković-Gašpić, Tahir Muhammad, Tukenmez-Tigen Elif, Zajkowska Joanna, ElKholy Jehan, Gašparović Hrvoje, Filiz Mine, Gul Ozlem, Tehrani Hamed Azhdari, Doyuk-Kartal Elif, Aybar-Bilir Yesim, Kahraman Hasip, Mikulić Hrvoje, Dayan Saim, Cascio Antonio, Yurdakul Eray Serdar, Colkesen Fatma, Karahangil Kadriye, Espinosa Angel, Rahimi Bilal Ahmad, Vangel Zdraveski, Fasciana Teresa, Giammanco Anna
Turkish Health Sciences University, Gülhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye.
Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain.
IJID Reg. 2025 Jan 8;14:100566. doi: 10.1016/j.ijregi.2025.100566. eCollection 2025 Mar.
Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery.
Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model.
Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, (n = 30, 17.9%) were the predominant microorganisms, whereas (n = 16, 9.6%), (n = 9, 5.4%), and (n = 7, 4.2%) were the most prevalent.
To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management.
心脏手术后手术部位感染（SSIs）会增加发病率和死亡率。这项多中心研究旨在确定心脏手术后与SSIs相关的死亡风险因素。
这项前瞻性研究于2023年1月至3月进行，纳入了167例年龄大于16岁的心脏手术后发生SSIs的患者。主要关注的是30天死亡率。采用单因素分析和利用向后排除法的多因素逻辑回归来建立最终模型。
几个因素与死亡率显著相关。这些因素包括导尿（比值比[OR]14.197；90%置信区间[CI]12.198 - 91.721）、急诊手术（OR 8.470[90%CI 2.028 - 35.379]）、瓣膜置换（OR 4.487[90%CI 1.001 - 20.627]）、较高的快速序贯器官衰竭评估评分（OR 3.147[90%CI 1.450 - 6.827]）、高龄（OR 1.075[90%CI 1.020 - 1.132]）以及SSI后30天内的术后再次干预（OR 14.832[90%CI 2.684 - 81.972]）。53例（31.7%）患者的伤口培养未分离出病原体。总共43.1%的SSIs（n = 72）是由革兰氏阳性微生物引起的，而27.5%的病例（n = 46）涉及革兰氏阴性菌。在革兰氏阳性菌中，（n = 30，17.9%）是主要微生物，而（n = 16，9.6%）、（n = 9，5.4%）和（n = 7，4.2%）是最常见的。
为降低心脏手术后的死亡率，严格的感染控制措施和有效的手术消毒至关重要，尤其是在老年患者中。疾病的临床进展通过快速序贯器官衰竭评估评分和患者再次干预来反映，有效的治疗是SSI管理的另一个重要组成部分。
