Abstract 12247: Infections After Cardiac Surgery: Initial Experience from the Cardiothoracic Surgical Trials Network
Objective: Hospital-acquired infections are the most common non-cardiac complication after cardiac surgery, but their true prevalence across a broad range of operations remains unknown. This study prospectively examines the time of occurrence and risk factors for postoperative infections within 60 days after cardiac surgery.
Methods: A prospective cohort study was conducted in 10 academic centers to assess major and minor infections based on CDC/NHSN surveillance definitions. Consented patients without active preop infection were enrolled between 2/1/10-9/30/10. All infections were adjudicated by an independent committee of ID experts. A multivariable regression model was developed to identify baseline characteristics associated with infection.
Results: 5,185 patients were enrolled (mean age 64.5±13.2 years). 74% of surgery was elective; the most frequently performed procedures were CABG (n=2521), aortic valve (n=1801), and mitral valve surgery (n=1314). There were 733 infections; 280 of which were major infections; the most common being pneumonia (2.4% of all patients), C. difficile colitis (0.93%), bloodstream infection (0.75%), deep incision surgical site infection (0.50%), and mediastinitis (0.23%). Major infections occurred 14.5 days (median) after surgery and 51% occurred post-discharge. 8% of patients experienced minor infections; the most prevalent being symptomatic UTI (3.3%) and superficial incision site infection (2.5%). Independent risk factors for major infections are summarized in Table 1.
Conclusion: Infections after cardiac surgery occur later than previously suspected, with many occurring only after hospital discharge. Moreover, focus has been on sternal wound infections, rather than on more prevalent ones, such as pneumonia and C. diff colitis. These observations should guide creation of more effective management strategies to reduce occurrence of all infections.
- © 2011 by American Heart Association, Inc.