Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study.
Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study.
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DOI：
10.3389/fmed.2023.1099351
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发表时间：
2023
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
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本研究旨在探讨心脏手术中应用细胞保存仪回收的红细胞细菌培养阳性的相关因素，以及这些阳性结果对术后感染相关发病率的影响。这项队列研究招募了204名计划在2021年7月至2022年7月期间接受心脏手术的患者，术中血细胞回收和回输。根据术中sRBC细菌培养结果将患者分为两组：培养(+)组和培养(−)组。对这些组的术前和术中变量进行了比较，目的是检测sRBC培养阳性的可能预测因素。此外，还比较了这些组之间术后感染相关发病率和其他临床结果的差异。在这些患者中，49%是sRBC培养(+)，表皮葡萄球菌是最常见的病原体。与sRBC培养阳性相关的独立危险因素有体重指数≥为25 kg/m2、吸烟史、手术时间≥为277.5分钟、手术室工作人员数量较多、手术顺序较高。SRBC培养(+)组患者的平均ICU住院时间较长[3.5天(2.0-6.0)比2天(1.0-4.0)，P<；与单纯红细胞培养(−)组相比，术后感染发生率高(22%比9.6%，P=0.02)，输血次数多，输血相关费用高[2,962(1,683.0-5,608.8)比2,525(1,532.3-3,595.0)，P=0.01]。此外，sRBC培养阳性是术后感染的独立危险因素(OR2.62，95%CI 1.16~5.90，P=0.02)。表皮葡萄球菌是本研究中培养(+)组sRBC中检测到的最常见的病原体，确定它是术后感染的潜在驱动因素。SRBC培养阳性可能是术后感染的原因之一，其发生率与患者体重指数、吸烟史、手术时间、手术室人员数量及手术顺序有关。
This study was designed to explore factors associated with the incidence of positive bacterial culture of salvaged red blood cells (sRBCs) recovered with a Cell Saver instrument during cardiac surgery and the impact of such positive outcomes on postoperative infection-related morbidity. The cohort study enrolled 204 patients scheduled for cardiac surgery with intraoperative blood cell salvage and retransfusion from July 2021 to July 2022. These patients were stratified into two groups based on intraoperative sRBCs bacterial culture results: culture (+) and culture (−) groups. Preoperative and intraoperative variables were compared between these groups aim to detect possible predictors of positive culture in sRBCs. In addition, differences in postoperative infection-related morbidity and other clinical outcomes were compared between these groups. Of these patients, 49% were sRBCs culture (+), with Staphylococcus epidermidis as the most commonly identified pathogen. Risk factors independently associated with the risk of positive culture in sRBCs included BMI ≥25 kg/m2, a history of smoking, an operative duration ≥277.5 min, the higher number of staff in the operating room and higher surgical case order. Patients in the sRBCs culture (+) group exhibited a longer average ICU stay [3.5 days (2.0–6.0) vs. 2 days (1.0–4.0), P < 0.01], a longer duration of ventilation [20.45 h (12.0–17.8) vs. 13 h (11.0–17.0, P = 0.02)], underwent more allogeneic blood transfusions, exhibited higher transfusion-related costs [2,962 (1,683.0–5,608.8) vs. 2,525 (1,532.3–3,595.0), P = 0.01], and had higher rates of postoperative infections (22 vs. 9.6%, P = 0.02) as compared to patients in the sRBCs culture (−) group. In addition, culture (+) in sRBCs was an independent risk factor for postoperative infection (OR 2.62, 95% CI 1.16–5.90, P = 0.02). Staphylococcus epidermidis was the most common pathogen detected in sRBCs in the culture (+) group in this study, identifying it as a potential driver of postoperative infection. Positive sRBCs culture may contribute to postoperative infection and its incidence was significantly associated with patient BMI, history of smoking, operative duration, the number of staff in the operating room and surgical case order.