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J Thorac Cardiovasc Surg 2007;133:590-591
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Microbiologically documented nosocomial infections after coronary artery bypass surgery without cardiopulmonary bypass

^a Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
^b Healthcare Department, Hogeschool Ghent, "Vesalius", Ghent, Belgium

To the Editor:

In the latest issue of the Journal of Thoracic and Cardiovascular Surgery, we read with great interest the article by Falagas and colleagues,¹ in which they evaluated the frequency, characteristics, and predisposing factors of microbiologically documented nosocomial infections in a well-defined subgroup of critically ill patients undergoing off-pump coronary artery bypass grafting. In this clearly and well-documented article, it is mentioned that there is a statistically significant difference, in terms of mortality, between patients having a documented infection and the rest of the patients (23.8% vs 1.2%, P < .001).¹ These data, however, should be interpreted with caution. When considering the main characteristics of the study cohort, patients with infection versus patients without infection already differ in terms of age and underlying conditions before the onset of infection. The authors themselves demonstrated clearly a statistically significant difference concerning left ventricular ejection fraction (better in the patient group with lower mortality). This cannot be neglected because it has widely been demonstrated that such organ dysfunctions are indispensably associated with increased mortality.² Here a logistic regression model with adjustment for possible confounding factors, such as length of hospitalization before infection, age, and severity of illness, could be used to assess the potential causative effect of infection on mortality. With regard to this, we wonder whether the authors can provide further details on the rate of patients receiving appropriate antimicrobial agents. This has been shown to significantly improve patient outcome.^3-5 Furthermore, with respect to the severity of illness, a certain estimation by means of, for example, EuroSCORE could explain possible differences of outcome measures between both groups. We would appreciate if Falagas and colleagues could elaborate on their report, keeping those issues in mind.

References

1. Falagas ME, Rosmarakis ES, Rellos K, Michalopoulos A, Samonis G, Prapas SN. Microbiologically documented nosocomial infections after coronary artery bypass surgery without cardiopulmonary bypass. J Thorac Cardiovasc Surg 2006;132:481-490.[Abstract/Free Full Text]
   
2. Blot SI, Depuydt P, Annemans L, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:1591-1598.[Abstract/Free Full Text]
   
3. Blot S, Vandewoude K. Early detection of systemic infections. Acta Clin Belg 2004;59:20-23.[Medline]
   
4. Colardyn F. Appropriate and timely empirical antimicrobial treatment of ICU infections—a role for carbapenems. Acta Clin Belg 2005;60:51-62.[Medline]
   
5. Kollef M. Appropriate empirical antibacterial therapy for nosocomial infections: getting it right the first time. Drugs 2003;63:2157-2168.[Medline]
   

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vandijck, D. M. Articles by Poelaert, J. I. Search for Related Content PubMed PubMed Citation Articles by Vandijck, D. M. Articles by Poelaert, J. I. Related Collections Related Article