Impact of nosocomial infections on patient mortality following cardiac surgery
Impact of nosocomial infections on patient mortality following cardiac surgery
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DOI：
10.1016/j.jclinane.2020.110104
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发表时间：
2021-05-01
影响因子：
6.7
通讯作者：
Heredia-Rodriguez, Maria
中科院分区：
文献类型：
--
作者：
de la Varga-Martinez, Olga;Gomez-Sanchez, Esther;Heredia-Rodriguez, Maria
研究目的：确定接受心脏手术的患者的院内感染率，并确定危险因素以及这些感染对患者死亡率的影响。设计：前瞻性观察研究。环境：重症监护病房 (ICU)。患者：2011 年 1 月至 2016 年 1 月期间在巴利亚多利德临床大学医院接受心脏手术的 1097 名成年患者。干预措施：无。测量：术前、术中和术后内科、外科主要结果：共有111名患者（10.1%）在术后发生院内感染。肺炎是最常见的院内感染（4.2%）。确定了发生院内感染的三个独立危险因素：体外循环时间、肾衰竭和急诊手术。发生院内感染的患者在 ICU 的停留时间显着更高（16.6 +/- 38.8 vs. 4.4 +/- 17.8，P < 0.001）。发生院内感染的患者死亡率（18%）显着高于未发生院内感染的患者（5%）（P < 0.001）。无院内感染的患者组的 90 天生存率更高（对数等级 27.55，P < 0.001）。 90天死亡率的动态模型显示，第一周内，体外循环时间（HR = 1.00，95% CI 1.00-1.02，P < 0.001）和急诊手术（HR = 0.12，95% CI 0.04-0.37，P < 0.001）是死亡的最重要危险因素，而第一周后，医院感染（HR = 0.12，95% CI 0.04-0.37，P < 0.001） 6.23，95% CI 2.49-15.63，P < 0.001）是主要危险因素，其次是体外循环时间（HR = 1.01，95% CI 1.00-1.01，P = 0.001）和 EuroSCORE（HR = 1.03，95% CI 1.00-1.06，P = 0.008）。结论：心脏手术后院内感染构成术后第一周死亡的主要独立危险因素。这些数据表明，必须优先考虑心脏手术后的预防，以改善患者的预后。
Study objective: To determine the rate of nosocomial infection among patients undergoing cardiac surgery and to identify risk factors and the impact of these infections on patient mortality.Design: Prospective observational study.Setting: Intensive Care Unit (ICU).Patients: 1097 adult patients who underwent cardiac surgery at Hospital Clinico Universitario de Valladolid between January 2011 and January 2016.Interventions: None.Measurements: Preoperative, intraoperative and postoperative medical, surgical and anaesthetic variables.Main results: A total of 111 patients (10.1%) acquired a nosocomial infection in the postoperative period. Pneumonia was the most frequent (4.2%) nosocomial infection. Three independent risk factors for the development of a nosocomial infection were identified: cardiopulmonary bypass time, kidney failure and emergency surgery. The stay in the ICU was significantly higher in patients who developed a nosocomial infection (16.6 +/- 38.8 vs. 4.4 +/- 17.8, P < 0.001). The mortality rate of patients who acquired a nosocomial infection was significantly greater (18%) than that of patients who did not acquire a nosocomial infection (5%) (P < 0.001). The 90-day survival was greater in the group of patients without nosocomial infection (log rank 27.55, P < 0.001). The dynamic modelling of 90-day mortality revealed that in the first week, cardiopulmonary bypass time (HR =1.00, 95% CI 1.00-1.02, P < 0.001) and emergency surgery (HR = 0.12, 95% CI 0.04-0.37, P < 0.001) were the most important risk factors for mortality, while after the first week, nosocomial infection (HR = 6.23, 95% CI 2.49-15.63, P < 0.001) was the main risk factor, followed by cardiopulmonary bypass time (HR = 1.01, 95% CI 1.00-1.01, P = 0.001) and EuroSCORE (HR = 1.03, 95% CI 1.00-1.06, P = 0.008).Conclusions: Nosocomial infections after cardiac surgery constitute the main independent risk factor for mortality after the first week of surgery. These data suggest that its prevention following cardiac surgery must be prioritised to improve patient outcomes.