Abstract
BackgroundST-elevation myocardial infarction (STEMI) patients have risk factors and co-morbidities and require procedures predisposing to healthcare acquired infections (HAIs). As few data exist on the extent and consequences of infections among these patients, the prevalence, predictors, and potential complications of major infections among hospitalized STEMI patients at all Florida acute care hospitals during 2006 were analyzed.MethodsSociodemographic characteristics, risk factors, co-morbidities, procedures, complications, and mortality were analyzed from hospital discharge data for 11, 879 STEMI patients age ≥18 years. We used multivariable logistic regression modeling to examine and adjust for multiple potential predictors of any infection, bloodstream infection (BSI), pneumonia, surgical site infection (SSI), and urinary tract infection (UTI).ResultsThere were 2, 562 infections among 16.6% of STEMI patients; 6.2% of patients had ≥2 infections. The most prevalent HAIs were UTIs (6.0%), pneumonia (4.6%), SSIs (4.1%), and BSIs (2.6%). Women were at 29% greater risk, Blacks had 23% greater risk, and HAI risk increased 11% with each 5 year increase in age. PCI was the only protective major procedure (OR 0.81, 95% CI, 0.69-0.95, p < .05). HAI lengthened hospital stays. STEMI patients with a BSI were almost 5 times more likely (31.3% vs. 6.5%, p < .0001), and those with pneumonia were 3 times more likely (19.6% vs. 6.5%, p < .0001) to die before discharge.ConclusionsThe protective effect of PCI on risk of infection is likely mediated by its many benefits, including reduced length of hospitalizations.
Highlights
ST-elevation myocardial infarction (STEMI) patients have risk factors and co-morbidities and require procedures predisposing to healthcare acquired infections (HAIs)
Over 80% of HAIs belong to four categories: urinary tract infection (UTI) (35% of all infections), surgical site infection (SSI) (20%), bloodstream infection (BSI) (15%), and pneumonia (15%) [2]
Among cardiac care unit (CCU) occupants, pneumonia, BSIs, and UTIs were strongly associated with invasive device implantation
Summary
ST-elevation myocardial infarction (STEMI) patients have risk factors and co-morbidities and require procedures predisposing to healthcare acquired infections (HAIs). Over 80% of HAIs belong to four categories: urinary tract infection (UTI) (35% of all infections), surgical site infection (SSI) (20%), bloodstream infection (BSI) (15%), and pneumonia (15%) [2]. Among cardiac care unit (CCU) occupants, pneumonia, BSIs, and UTIs were strongly associated with invasive device implantation (i.e. mechanical ventilator, catheter). Overall incidence of CCU-acquired HAIs was less than in other ICUs, attributable to less frequent use of invasive devices [7]. Reperfusion therapy may cause HAI, by frequent use of invasive devices and procedures and procedure-related complications, e.g. contrastinduced nephropathy. While infrequently utilized for STEMI patients, surgical revascularization increases the risk for surgical site infections, pneumonia, and UTIs [8,9]
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