Abstract 805: Prevalence of Major Infections and In-Hospital Mortality Among Hospitalized Acute Myocardial Infarction Patients in Florida
Background: ST elevation myocardial infarction (STEMI) patients often have certain characteristics and/or require procedures that increase their risk of healthcare acquired infections (HAIs). HAIs are associated with higher rates of in-hospital mortality among general inpatients, but few data exist on the extent of this problem among hospitalized STEMI patients.
Methods: We analyzed hospital discharge data for 11,879 patients aged 18+ years with a principal diagnosis of STEMI. Infections were identified through secondary diagnosis fields coded to ICD 9-CM, using CDC surveillance guidelines. Sociodemographic characteristics, risk factors, co-morbidities, procedures, complications and mortality were also identified. We used logistic regression modeling to examine and adjust for multiple potential predictors of any infection, bloodstream infection (BSI), pneumonia, surgical site infection (SSI), and urinary tract infection (UTI).
Results: We found 2,562 infections among 16.6% of STEMI patients and 6.2% of patients had two or more infections. UTI was the most prevalent type (6.0%), pneumonia (4.6%), miscellaneous infection (4.2%), SSI (4.1%) and BSI (2.6%). Overall, infected STEMI patients had a significantly greater likelihood of potential complications. Patients with BSIs had the longest length of stay and the highest mortality rate. They were 5 times as likely to remain hospitalized for more than 7 days (75.7% vs. 15.5%, p<.0001) and were 5 times as likely to die prior to discharge (31.3% vs. 6.5%, p<.0001). Patients with pneumonia were 4 times more likely to stay hospitalized longer than 7 days (65.5% vs. 155%, p<.0001) and 3 times more likely to die prior to discharge (19.6% vs. 6.5%, p<.0001). Infected STEMI patients had a much higher likelihood of mechanical ventilation and acute renal and heart failure. Notably, patients with miscellaneous infections, not those with pneumonia, had the greatest risk of mechanical ventilation (25.1% vs. 5.4%, p<.0001).
Conclusions: Our study identified important infectious complications among STEMI patients that prolonged recovery and/or increased mortality. Further research is needed to reduce the occurrence of in-hospital mortality among this high-risk population.
This research has received full or partial funding support from the American Heart Association, Greater Southeast Affiliate (Alabama, Florida, Georgia, Louisiana, Mississippi, Puerto Rico & Tennessee).