Management practices and major infections after cardiac surgery

Annetine C. Gelijns, Alan J. Moskowitz, Michael A. Acker, Michael Argenziano, Nancy L. Geller, John D. Puskas, Louis P. Perrault, Peter K. Smith, Irving L. Kron, Robert E. Michler, Marissa A. Miller, Timothy J. Gardner, Deborah D. Ascheim, Gorav Ailawadi, Pamela Lackner, Lyn A. Goldsmith, Sophie Robichaud, Rachel A. Miller, Eric A. Rose, T. Bruce FergusonKeith A. Horvath, Ellen G. Moquete, Michael K. Parides, Emilia Bagiella, Patrick T. O'Gara, Eugene H. Blackstone

Research output: Contribution to journalArticle

61 Scopus citations

Abstract

Background Infections are the most common noncardiac complication after cardiac surgery, but their incidence across a broad range of operations, as well as the management factors that shape infection risk, remain unknown. Objectives This study sought to prospectively examine the frequency of post-operative infections and associated mortality, and modifiable management practices predictive of infections within 65 days from cardiac surgery. Methods This study enrolled 5,158 patients and analyzed independently adjudicated infections using a competing risk model (with death as the competing event). Results Nearly 5% of patients experienced major infections. Baseline characteristics associated with increased infection risk included chronic lung disease (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.21 to 2.26), heart failure (HR: 1.47; 95% CI: 1.11 to 1.95), and longer surgery (HR: 1.31; 95% CI: 1.21 to 1.41). Practices associated with reduced infection risk included prophylaxis with second-generation cephalosporins (HR: 0.70; 95% CI: 0.52 to 0.94), whereas post-operative antibiotic duration >48 h (HR: 1.92; 95% CI: 1.28 to 2.88), stress hyperglycemia (HR: 1.32; 95% CI: 1.01 to 1.73); intubation time of 24 to 48 h (HR: 1.49; 95% CI: 1.04 to 2.14); and ventilation >48 h (HR: 2.45; 95% CI: 1.66 to 3.63) were associated with increased risk. HRs for infection were similar with either <24 h or <48 h of antibiotic prophylaxis. There was a significant but differential effect of transfusion by surgery type (excluding left ventricular assist device procedures/transplant) (HR: 1.13; 95% CI: 1.07 to 1.20). Major infections substantially increased mortality (HR: 10.02; 95% CI: 6.12 to 16.39). Conclusions Major infections dramatically affect survival and readmissions. Second-generation cephalosporins were strongly associated with reduced major infection risk, but optimal duration of antibiotic prophylaxis requires further study. Given practice variations, considerable opportunities exist for improving outcomes and preventing readmissions. (Management Practices and Risk of Infection Following Cardiac Surgery; NCT01089712).

Original languageEnglish (US)
Pages (from-to)372-381
Number of pages10
JournalJournal of the American College of Cardiology
Volume64
Issue number4
DOIs
StatePublished - Jul 29 2014

Keywords

  • cardiac surgery
  • infection
  • risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Gelijns, A. C., Moskowitz, A. J., Acker, M. A., Argenziano, M., Geller, N. L., Puskas, J. D., Perrault, L. P., Smith, P. K., Kron, I. L., Michler, R. E., Miller, M. A., Gardner, T. J., Ascheim, D. D., Ailawadi, G., Lackner, P., Goldsmith, L. A., Robichaud, S., Miller, R. A., Rose, E. A., ... Blackstone, E. H. (2014). Management practices and major infections after cardiac surgery. Journal of the American College of Cardiology, 64(4), 372-381. https://doi.org/10.1016/j.jacc.2014.04.052