Bloodstream, respiratory, and deep surgical wound infections after open heart surgery

Nosocomial infections are one of the most feared complications after open h eart surgery. A large retrospective study was conducted to evaluate the nat ure and scope of the problem. Between 1992 and 1998, 9352 patients who had undergone open heart surgery were evaluated. Bloodstream infections, pneumo nia, and deep sternal wound infections were included. Univariate and logist ic regression analyses were conducted to identify the high-risk patients th at were likely to become infected. Three hundred forty-six infections in 27 6 patients were diagnosed. Age, preoperative albumin level, banked blood re quirement, duration of operation, diabetes mellitus, previous open heart su rgery, moderate or severe pericardial adhesions, obesity, postoperative low cardiac output, and postoperative cerebrovascular accident were found to b e significant in univariate and logistic regression analyses for infectious outcome. Univariate analysis also revealed additional significant factors: fresh frozen plasma requirement, duration of cardiopulmonary bypass and cr oss-clamp, preoperative high levels of blood urea and glucose, presence of occlusive peripheral arterial disease, preoperative history of hypertension , and nasal carriage of Staphylococcus aureus. Methicillin resistant S. aur eus was involved in 58.4% of the infections. Risk factors should be individ ualized for patients and every effort should be carried out to minimize inf ectious outcome.