Abstract
Objective:to determine the microbiological characteristics of the red blood cells obtained with the cell saver in heart surgery patients on an extra-body circuit.Method:a cross-sectional and descriptive study conducted with 358 patients scheduled for heart surgery where the saver was used. Sociodemographic variables were collected, as well as from the saver and of the microbial identification in the re-infusion bag proceeding from the cell saver. Informed consent performed.Results:of the 170 GRAM+ bacteria isolations, the most frequent species were Staphylococcus epidermidis in 69% (n=138) of the cases and Streptococcus sanguinis with a report of 10% (n=20). Significant differences were found in the Staphylococcus epidermidis strain in patients with a Body Mass Index ≥25 (p=0.002) submitted to valve surgery (p=0.001). Vancomycin was the antimicrobial which resisted the Staphylococcus epidermidis strain with a minimum inhibitory concentration of >16 µg/ml.Conclusion:the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis. Consequently, in order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol.
Highlights
Invasive infections during heart surgery have been reported internationally[1]; bacterial contamination outbreaks have been described recently in the cooling-heating devices used to regulate the patient’s blood temperature during the extra-body flow through the closed water circuits[2]
Conclusion: the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis
In order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol
Summary
Invasive infections during heart surgery have been reported internationally[1]; bacterial contamination outbreaks have been described recently in the cooling-heating devices used to regulate the patient’s blood temperature during the extra-body flow through the closed water circuits[2]. Knowing that heart surgery is the medical specialty which consumes the most blood products[9], the cell saver (CS) is used, a device which recovers blood losses from the surgical field and from the residual volume of the extra-body circuit to submit it to a “cleaning” process, obtaining a certain volume of red blood cells which is reinfused into the patient (reinfusion bag). This fact gains importance because the presence of bacteremia in the patient is associated with vascular accesses, prolonged hospitalizations, treatments in intensive care units, and administration of multiple broad-range antibiotics where immunosuppresion is the most important comorbidity and where mortality is significant[14]
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