Objective: To define the incidence, risk factors, and characteristics of bl
oodstream infections (BSIs) after invasive nonsurgical cardiologic procedur
es (ICPs).
Methods: Retrospective case-control study; multivariate analysis.
Results: Between January 1991 and December 1998, 22006 ICPs were performed
in our hospital and 25 BSIs were documented within 72 hours after ICP. Over
all incidence of bacteremia was 0.11% (25 cases) (0.24% after percutaneous
transluminal coronary angioplasty [14 cases of 5625 patients], 0.6% after d
iagnostic cardiac catheterization [9 cases of 14034 patients], and 0.8% aft
er electrophysiologic studies [2 cases of 2347 patients]). These 25 patient
s with bacteremia were compared with 50 controls randomly selected among pa
tients who underwent an ICP but did not have BSIs. Patient-related risk fac
tors for BSI were age older than 60 years (20 cases [80%] vs 28 controls [5
6%]), valvular disease (4 [16%] vs 1 [2%]), congestive heart failure (7 [28
%] vs I [ 2%]), indwelling bladder catheter before the ICP (5 [20%] vs 1 [2
%]), more than I puncture for the ICP (5 [20%] vs 3 [6%]), a prolonged proc
edure (83.7 vs 65.1 minutes); and/or more than I ICP performed (2 [8%] vs 0
). Multivariate analysis identified the presence of congestive heart failur
e (odds ratio, 21; 95% confidence interval, 6.8-66.0) and age older than 60
years (odds ratio, 1.9; 95% confidence interval, 1.9-6.3) as independent r
isk factors for BSI after ICP. Bloodstream infection was detected a median
of 1.7 days after the procedure. Gram-negative bacteremia accounted for 17
cases (68%) of the BSIs. Among the patients with BSI, the duration of hospi
tal stay was significantly increased (21 vs 6 days). The overall mortality
rate was 0.009% for patients who underwent an ICP (8.0% for the 25 patients
with bacteremia documented within 72 hours after ICP).
Conclusions: Bloodstream infection should be included among the potential c
omplications of ICP. Elderly patients with recent congestive heart failure
episodes constitute a subgroup with a higher risk of postprocedure bacterem
ia. Therapy with antimicrobial agents against gram-positive and gram-negati
ve bacteremia should be initiated after performing blood cultures in patien
ts with signs suggestive of infection.