CHARACTERISTICS OF THE EPIDEMIC PROCESS OF HEALTHCARE-ASSOCIATED INFECTIONS IN CARDIAC SURGERY

41 Association between postoperative infection and blood transfusions in cardiac surgery in king faisal cardiac center, 2016 to 2019

An economic evaluation of two interventions for the prevention of post-surgical infections in cardiac surgery

A pilot randomised controlled single-blind trial of a collagen implant for the prevention of sternal wound infection in cardiac surgery

BackgroundBlood transfusion is a commonly used therapy in cardiac surgery, whether it is given during the surgery or in the intensive care unit. It is important to evaluate the risks and benefits of exposure to blood transfusion. The use of blood transfusions can influence patient outcome. Previous studies have implicated blood transfusion as a causative factor in post-operative infection.ObjectivesWe aim to determine the effect of blood transfusion on post-operative infection in cardiac surgery patients at the King Faisal Cardiac Center, Jeddah, Saudia Arabia, from January 2017 to January 2019.MethodsThe regular six-week follow-up of cardiac surgery patients allowed us to maintain a six-week infection span. The main variables included patient characteristics, operative characteristics, pre-operative hemoglobin, six-week infection, blood transfusion, and clinical outcomes. A logistic regression model was developed to identify patient and procedure variables that were associated with blood transfusion and infection. The baseline variables were entered into the model. Variables with p-value less than 0.05 were considered significant.ResultsThe incidence of transfusion out of 197 patients was 93.4% (n = 184). The occurrence of infection was 31.82% (n = 63). There was no difference in post-operative infection for patients who received blood transfusions compared with those who did not receive blood transfusions (p = 0.902). In comparing patients receiving 1-2 units of red blood cells (RBCs) (48%) and those receiving >2 units of RBCs (52%), there was no significance (p = 0.549).ConclusionsThere was no association between the incidence of infection and blood transfusion. While there are other reasons for withholding blood, it would not be recommended to do so based on the concern of infection.

Background: Surgical site infections (SSIs) are among the most common and costly complications following cardiac surgery, significantly affecting morbidity and mortality rates. Traditional risk assessment models often fail to capture complex interactions among variables, limiting predictive precision. Recent advances in artificial intelligence (AI) offer opportunities to enhance infection prediction and prevention. Objective: To assess the prevalence of surgical site infections in cardiac surgery patients and identify associated risk factors using AI-driven analysis tools. Methods: This cross-sectional study was conducted over eight months (June 2024–February 2025) at two tertiary care cardiac centers. A total of 600 adult patients undergoing cardiac surgery were enrolled based on defined inclusion and exclusion criteria. Data were collected from electronic health records and included demographic, preoperative, intraoperative, and postoperative variables. Surgical site infections were diagnosed using CDC criteria and validated through independent clinical review. Statistical analysis included univariate and multivariate logistic regression, while machine learning models—Random Forest and Gradient Boosting—were developed to assess predictive accuracy. Results: SSIs occurred in 14% of patients (n=84), with superficial incisional infections being most common. Diabetes (OR 2.5), obesity (OR 2.1), surgery duration >5 hours (OR 3.2), re-exploration (OR 4.0), and prolonged ventilation (OR 3.5) were significant independent predictors. Gradient Boosting demonstrated superior predictive performance with an AUC-ROC of 0.91 compared to 0.89 for Random Forest. Conclusion: The integration of AI models enhances the predictive accuracy of SSI risk stratification in cardiac surgery. Early identification of high-risk patients through AI tools can support targeted prevention strategies and improve surgical outcomes.

Sternal surgical wound infection (SSWI) in cardiac surgery is associated with increased morbidity. We investigated the incidence of SSWI, the main germs implicated and predictors of SSWI. Prospective study including patients undergoing full median sternotomy between January 2017 and December 2019. Patients were followed-up for 3 months after hospital discharge. All sternal wound infections up to 90 days after discharge were considered SSWI. 1004 patients were included. During follow-up, 68 (6.8%) patients presented SSWI. Patients with SSWI had a higher incidence of postoperative renal failure (29.4% vs 17.1%, P=.007), a higher incidence of early postoperative reoperation for non-infectious causes (42.6% vs 9.1%, P < .001), longer ICU stay (3 [2-9] days vs 2 [2-4] days, P=.006), and longer hospital stay (24.5 [14.8-38.3] days vs 10 [7-18] days, P < .001). Gram-positive germs were presented in 49% of the cultures, and gram-negative bacteria in 35%. Early reoperation for non-infectious causes (OR 4.90, 95% CI 1.03-23.7), and a longer ICU stay (OR 1.37 95% CI 1.10-1.72) were independent predictors of SSWI. SSWI is rare but leads to more postoperative complications. The need for early reoperation because of non-infectious cause and a longer ICU stay were independently associated with SSWI.

Literature review

A prospective study of nosocomial infections in cardiac surgery pots in China

Effect of Hospital-associated SARS-CoV-2 Infections in Cardiac Surgery: A Multicenter Study

The global outbreak of Mycobacterium chimaera infections in cardiac surgery—a systematic review of whole-genome sequencing studies and joint analysis

Acute kidney injury (AKI) occurs in 7% to 18% of hospitalized patients and complicates the course of 50% to 60% of those admitted to the intensive care unit, carrying both significant mortality and morbidity.[1][1] Even though many cases of AKI are reversible within days to weeks of occurrence, data

Postoperative surgical site infections are a major cause of postoperative morbidity and mortality in cardiac surgery. A surgical site infection occurs when the contaminating pathogens overcome the host defense systems and an infectious process begins. Bacteria may enter the operating site either by direct contamination from the patient's skin or internal organs, through the hands and instruments of the surgical staff or by bacteria-carrying particles that float around in the operating theatre and may land in the wound. The ability to withstand the contaminating bacteria depends on both local and systemic host defense. Successful preventive strategies are multiple and must include: 1) Minimizing the bacterial contamination of the surgical site (skin preparation, operating room ventilation, scrubbing, double gloving, etc.), 2) Minimizing the consequences of virulent contaminating bacteria by antibiotic prophylaxis (adequate dose, sort, timing, duration), 3) Minimizing injury to local host defense (atraumatic surgery, no excessive electrocautery, meticulous hemostasis, etc.), and 4) Optimizing general host defense (nutrition, tobacco smoking, weight loss, etc.). Compliance with these preventive procedures must be enforced through regular reviews of performance. Non-compliance with hygiene routines is often due to ignorance and poor planning. Education of personnel in these issues is a continuous process.

An Analysis of the Association Between Preoperative Renal Dysfunction and Outcome in Cardiac Surgery : Estimated Creatinine Clearance or Plasma Creatinine Level as Measures of Renal Function

The reported incidence of deep sternal wound infection (DSWI) after cardiac surgery is 0.4-5% with Staphylococcus aureus being the most common pathogen isolated from infected wound sternotomies and bacteraemic blood cultures. This infection is associated with a higher morbidity and mortality than other known aetiologies. Little is reported about the optimal antibiotic management. The aim of the study is to quantify the application of daptomycin treatment of DSWI due to gram-positive organisms post cardiac surgery.We performed an observational analysis in 23 cases of post sternotomy DSWI with gram-positive organisms February 2009 and September 2010. When the wound appeared viable and the microbiological cultures were negative, the technique of chest closure was individualised to the patient.The incidence of DSWI was 1.46%. The mean dose of daptomycin application was 4.4 ± 0.9 mg/kg/d and the average duration of the daptomycin application was 14.47 ± 7.33 days. In 89% of the patients VAC therapy was used. The duration from daptomycin application to sternal closure was 18 ± 13.9 days. The parameters of infection including, fibrinogen (p = 0.03), white blood cell count (p = 0.001) and C-reactive protein (p = 0.0001) were significantly reduced after daptomycin application. We had no mortality and wound healing was successfully achieved in all patients.Treatment of DSWI due to gram-positive organisms with a daptomycin-containing antibiotic regimen is safe, effective and promotes immediate improvement of local wound conditions.Based on these observations, daptomycin may offer a new treatment option for expediting surgical management of DSWI after cardiac surgery.

Preoperative anemia management in the coronavirus disease (COVID-19) era