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J Thorac Cardiovasc Surg 1996;112:908-913
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

NOSOCOMIAL INFECTIONS IN PATIENTS HAVING CARDIOVASCULAR OPERATIONS: A MULTIVARIATE ANALYSIS OF RISK FACTORS

From the Department of Cardiovascular Surgery and Division of Epidemiology and Preventive Medicine, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain.

Received for publication August 28, 1995 Revisions requested Nov. 20, 1995; revisions received Jan. 22, 1996 Accepted for publication Feb. 8, 1996. Address for reprints: José M. Bernal, MD, Cardiovascular Surgery, Hospital Universitario Valdecilla, E-39008 Santander, Spain.

Abstract

A total of 970 adult patients undergoing cardiovascular operations during a 1-year period were eligible for a case-control study on the risk factors for nosocomial infection. Cases were defined as patients in whom a postoperative infection developed. Every case was paired with one uninfected subject. Nosocomial infection occurred in 89 (9.2%) patients. A total of 120 episodes of infection were diagnosed (1.3 episodes per patient). The infection ratio was 12.4%. Surgical site infection was the most common (5.6%), followed by pneumonia (3.2%), urinary tract infection requiring the use of intravenous antibiotics (1.8%), deep surgical site (0.9%), and bacteremia (0.7%). Advanced age, urgent intervention, duration of surgical procedure, blood transfusion, and use of invasive procedures (urinary catheter, chest tubes, nasogastric tube passage) were significantly associated with infection in the bivariate analysis. Nosocomial infection resulted in a significant increase in the length of hospital stay. Cases showed an almost fivefold greater risk of death than controls (odds ratio, 4.73; 95% confidence interval, 1.11 to 6.83; p = 0.009). Age older than 65 years, female sex, and mode of surgical intervention were selected in the multivariate analysis for patients undergoing cardiac operations, whereas general anesthesia or assisted ventilation, central venous catheter, and blood transfusion were the variables selected for patients undergoing operation for vascular disorders. In summary, the recognition of risk factors for postoperative infection in patients undergoing cardiovascular surgical procedures may contribute to improve their prognosis and to more organized surveillance and control activities in the hospital environment. (J THORAC CARDIOVASC SURG 1996;112:908-13)

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