• Medicina intensiva · Dec 2013

    Multicenter Study Observational Study

    Invasive device-related infections after heart surgery.

    • F Álvarez Lerma, M Carrasco, J J Otal, M Palomar, P Olaechea, X Peris, L Iglesias, A Martínez Pellus, A Arenzana, J C Ballesteros, and Grupo de Estudio ENVIN-HELICS.
    • Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España. Electronic address: Falvarez@imas.imim.es.
    • Med Intensiva. 2013 Dec 1;37(9):584-92.

    ObjectiveTo analyze postoperative infections in critically ill patients undergoing heart surgery.SettingIntensive care units (ICUs).DesignAn observational, prospective, multicenter study was carried out.PatientsPatients in the postoperative period of heart surgery admitted to the ICU and included in the ENVIN-HELICS registry between 2005 and 2011.Main Outcome VariablesMechanical ventilation associated pneumonia (MVP), urinary catheter-related infection (UCI), primary bacteremia (PB), PB related to vascular catheters (PB-VC) and secondary bacteremia.ResultsOf a total of 97,692 patients included in the study, 9089 (9.3%) had undergone heart surgery. In 440 patients (4.8%), one or more infections were recorded. Infection rates were 9.94 episodes of MVP per 1000 days of mechanical ventilation, 3.4 episodes of UCI per 1000 days of urinary catheterization, 3.10 episodes of BP-VC per 1000 days of central venous catheter, and 1.84 episodes of secondary bacteremia per 1000 days of ICU stay. Statistically significant risk factors for infection were ICU stay (odds ratio [OR] 1.18, 95%CI 1.16-1.20), APACHE II upon admission to the ICU (OR 1.05, 95%CI 1.03-1.07), emergency surgery (OR 1.67, 95%CI 1.13-2.47), previous antibiotic treatment (OR 1.38, 95%CI 1.04-1.83), and previous colonization by Pseudomonas aeruginosa (OR 18.25, 95%CI 3.74-89.06) or extended spectrum beta-lactamase producing enterobacteria (OR 16.97, 95%CI 5.4-53.2). The overall ICU mortality rate was 4.1% (32.2% in patients who developed one or more infections and 2.9% in uninfected patients) (P < .001).ConclusionsOf the patients included in the ENVIN-HELICS registry, 9.3% were postoperative heart surgery patients. The overall mortality was low but increased significantly in patients who developed one or more infection episodes.Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

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