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  • 1 Egyesített Szent István és Szent László Kórház Budapest Hungary
  • 2 Gottsegen György Hungarian Institute of Cardiology Budapest Hungary
  • 3 Semmelweis University of Medicine Department of Anaesthesiology and Intensive Care Budapest Hungary
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Nosocomial bloodstream infection (BSI) is a common finding in cardiac surgery intensive care units and is associated with excess mortality and hospital costs. Additional data are needed about incidence, characteristics, predictors, associated microorganisms of nosocomial BSI in cardiac surgical patients in order to refine measures to prevent nosocomial infections and to improve recovery outcomes in this patient population. The 3912 cardio-thoracic surgery patients from all age groups were admitted to the study at the Gottsegen György Hungarian Institute of Cardiology between January 1999 and December 2000. In each patient with BSI demographic, epidemiological and clinical variables were recorded along with potential risk factors. Incidence of associated pathogens and their possible sources were evaluated and outcome and mortality risk factors were assessed. There were a total of 134 episodes of BSI. The incidence was 34.25 per 1000 admissions. The leading microorganisms were staphylococci (37.7%). Bacteremic episodes developed secondary to an identifiable source in 27.6% of the cases, or were catheter-related (16.4%). In 56% of the cases the source was not identified. The crude mortality rate was 33.3%. Higher mortality rate was associated with intracardial grafts (p < 0.05), low left ventricular ejection fraction (p < 0.04), diabetes mellitus (p < 0.05), an age above 16 years (p < 0.02), severe sepsis (p < 0.001) and high APACHE II score (p < 0.001). As the identified main sources of BSI were intravascular lines, mortality from BSI could probably be reduced by paying more attention to the prevention, early recognition and prompt management of intravascular device associated infections.

  • Pittet, D., Tarara, D., Wenzel, R. P.: Nosocomial bloodstream infection in critically ill patient. Excess length stay, extra cost, and attributable mortality. JAMA 271, 1598–1601 (1994).

    Wenzel R. P. , 'Nosocomial bloodstream infection in critically ill patient. Excess length stay, extra cost, and attributable mortality ' (1994 ) 271 JAMA : 1598 -1601.

    • Search Google Scholar
  • Valles, J., Leon, C., Alvarez-Lerma, F.: Related Nosocomial bacteremia in critically ill patients: A multicenter study evaluating epidemiology and prognosis. Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC). Clin. Infect. Dis. 24, 387–395 (1997).

    Alvarez-Lerma F. , 'Related Nosocomial bacteremia in critically ill patients: A multicenter study evaluating epidemiology and prognosis. Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC) ' (1997 ) 24 Clin. Infect. Dis. : 387 -395.

    • Search Google Scholar
  • Richards, M. J., Edwards, J. R., Culver, D. H., Gaynes, R. P.: Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect. Control Hosp. Epidemiol. 21, 510–515 (2000).

    Gaynes R. P. , 'Nosocomial infections in combined medical-surgical intensive care units in the United States ' (2000 ) 21 Infect. Control Hosp. Epidemiol. : 510 -515.

    • Search Google Scholar
  • Kollef, M. H., Sharpless, L., Vlasnik, J., Pasque, C., Murphy, D., Fraser, V. J.: The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest 112, 666–675 (1997).

    Fraser V. J. , 'The impact of nosocomial infections on patient outcomes following cardiac surgery ' (1997 ) 112 Chest : 666 -675.

    • Search Google Scholar
  • Michalopoulos, A., Stavridis, G., Geroulanos, S.: Severe sepsis in cardiac surgical patients. Eur. J. Surg. 164, 217–222 (1998).

    Geroulanos S. , 'Severe sepsis in cardiac surgical patients ' (1998 ) 164 Eur. J. Surg. : 217 -222.

    • Search Google Scholar
  • Levy, I., Ovadia, B., Erez, E., Rinat, S., Ashkenazi, S., Birk, E., Konisberger, H., Vidne, B., Dagan, O.: Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J. Hosp. Infect. 53, 111–116 (2003).

    Dagan O. , 'Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors ' (2003 ) 53 J. Hosp. Infect. : 111 -116.

    • Search Google Scholar
  • Michalopoulos, A., Geroulanos, S., Rosmarakis, E. S., Falagas, M. E.: Frequency, characteristics, and predictors of microbiologically documented nosocomial infections after cardiac surgery. Eur. J. Cardiothorac. Surg. 29, 456–460 (2006).

    Falagas M. E. , 'Frequency, characteristics, and predictors of microbiologically documented nosocomial infections after cardiac surgery ' (2006 ) 29 Eur. J. Cardiothorac. Surg. : 456 -460.

    • Search Google Scholar
  • Levy, M. M., Fink, M. P., Marshall, J. C., Abraham, E., Angus, D., Cook, D., Cohen, J., Opal, S. M., Vincent, J. L., Ramsay, G.: 2001 SCCM/ESICM/ACCP /ATS/SIS International Sepsis Definitions Conference. Crit. Care Med. 31, 1250–1256 (2003).

    Ramsay G. , '2001 SCCM/ESICM/ACCP /ATS/SIS International Sepsis Definitions Conference ' (2003 ) 31 Crit. Care Med. : 1250 -1256.

    • Search Google Scholar
  • Goldstein, B., Giroir, B., Randolph, A.: International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr. Crit. Care Med. 6, 2–8 (2005).

    Randolph A. , 'International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics ' (2005 ) 6 Pediatr. Crit. Care Med. : 2 -8.

    • Search Google Scholar
  • Knaus, W. A., Draper, E. A., Wagner, D. P., Zimmerman, J. E.: APACHE II: A severity of disease classification system. Crit. Care Med. 13, 818–829 (1985).

    Zimmerman J. E. , 'APACHE II: A severity of disease classification system ' (1985 ) 13 Crit. Care Med. : 818 -829.

    • Search Google Scholar
  • Pollack, M. R., Ruttimann, U. E., Getson, P. R.: Pediatric risk of mortality (PRISM) score. Crit. Care Med. 16, 1110–1116 (1988).

    Getson P. R. , 'Pediatric risk of mortality (PRISM) score ' (1988 ) 16 Crit. Care Med. : 1110 -1116.

    • Search Google Scholar
  • Weinstein, M. P., Towns, M. L., Quartey, S. M., Mirrett, S., Reimer, L. G., Parmigiani, G., Reller, L. B.: The clinical significance of positive blood cultures in the 1990s: A prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin. Infect. Dis. 24, 584–602 (1997).

    Reller L. B. , 'The clinical significance of positive blood cultures in the 1990s: A prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults ' (1997 ) 24 Clin. Infect. Dis. : 584 -602.

    • Search Google Scholar
  • Gordon, S. M., Serkey, J. M., Keys, T. F., Ryan, T., Fatica, C. A., Schmitt, S. K., Borsch, J. A., Cosgrove, D. M., Yared, J. P.: Secular trends in nosocomial bloodstream infections in a 55-bed cardiothoracic intensive care unit. Ann. Thorac. Surg. 65, 95–100 (1998).

    Yared J. P. , 'Secular trends in nosocomial bloodstream infections in a 55-bed cardiothoracic intensive care unit ' (1998 ) 65 Ann. Thorac. Surg. : 95 -100.

    • Search Google Scholar
  • Wisplinghoff, H., Bischoff, T., Tallent, S. M., Seifert, H., Wenzel, R. P., Edmond, M. B.: Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study. Clin. Infect. Dis. 39, 309–317 (2004).

    Edmond M. B. , 'Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study ' (2004 ) 39 Clin. Infect. Dis. : 309 -317.

    • Search Google Scholar
  • Panceri, M. L., Vegni, F. E., Goglio, A., Manisco, A., Tambini, R., Lizioli, A., Porretta, A. D., Privitera, G.: Aetiology and prognosis of bacteremia in Italy. Epidemiol. Infect. 132, 647–654 (2004).

    Privitera G. , 'Aetiology and prognosis of bacteremia in Italy ' (2004 ) 132 Epidemiol. Infect. : 647 -654.

    • Search Google Scholar
  • Khuri-Bulos, N. A., Shennak, M., Agabi, S., Saleh, S., Al Rawashdeh, S., Al Ghanem, S., Al Adham, M., Faori, I., Abu Khader, I.: Nosocomial infections in the intensive care units at a university hospital in a developing country: comparison with National Nosocomial Infections Surveillance intensive care unit rates. Am. J. Infect. Control 27, 547–552 (1999).

    Abu Khader I. , 'Nosocomial infections in the intensive care units at a university hospital in a developing country: comparison with National Nosocomial Infections Surveillance intensive care unit rates ' (1999 ) 27 Am. J. Infect. Control : 547 -552.

    • Search Google Scholar
  • O’Grady, N. P., Alexander, M., Dellinger, E. P., Gerberding, J. L., Heard, S. O., Maki, D. G., Masur, H., McCormick, R. D., Mermel, L. A., Pearson, M. L., Raad, I. I., Randolph, A., Weinstein, R. A.: Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Infect. Control Hosp. Epidemiol. 23, 759–769 (2002).

    Weinstein R. A. , 'Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections ' (2002 ) 23 Infect. Control Hosp. Epidemiol. : 759 -769.

    • Search Google Scholar
  • Karchmer, A. W.: Nosocomial bloodstream infections: Organisms, risk factors, and implications. Clin. Infect. Dis. 31, S319–343 (2000).

    Karchmer A. W. , 'Nosocomial bloodstream infections: Organisms, risk factors, and implications ' (2000 ) 31 Clin. Infect. Dis. : S319 -343.

    • Search Google Scholar
  • Laupland, K. B., Kirkpatrick, A. W., Church, D. L., Ross, T., Gregson, D. B.: Intensive-care-unit-acquired bloodstream infections in a regional critically ill population. J. Hosp. Infect. 58, 137–145 (2004).

    Gregson D. B. , 'Intensive-care-unit-acquired bloodstream infections in a regional critically ill population ' (2004 ) 58 J. Hosp. Infect. : 137 -145.

    • Search Google Scholar
  • Ronveaux, O., Jans, B., Suetens, C., Carsauw, H.: Epidemiology of nosocomial bloodstream infections in Belgium, 1992–1996. Eur. J. Clin. Microbiol. Infect. Dis. 17, 695–700 (1998).

    Carsauw H. , 'Epidemiology of nosocomial bloodstream infections in Belgium, 1992–1996 ' (1998 ) 17 Eur. J. Clin. Microbiol. Infect. Dis. : 695 -700.

    • Search Google Scholar
  • Fluit, A. C., Schmitz, F. J., Verhoef, J. and the European SENTRY Participant Group: Frequency of isolation of pathogens from bloodstream, nosocomial pneumonia, skin and soft tissue, and urinary tract infections occurring in European patients. Eur. J. Clin. Microbiol. Infect. Dis. 20, 188–191 (2001).

    Verhoef J. , 'Frequency of isolation of pathogens from bloodstream, nosocomial pneumonia, skin and soft tissue, and urinary tract infections occurring in European patients ' (2001 ) 20 Eur. J. Clin. Microbiol. Infect. Dis. : 188 -191.

    • Search Google Scholar
  • Biedenbach, D. J., Moet, G. J., Jones, R. N.: Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002). Diagn. Microbiol. Infect. Dis. 50, 59–69 (2004).

    Jones R. N. , 'Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002) ' (2004 ) 50 Diagn. Microbiol. Infect. Dis. : 59 -69.

    • Search Google Scholar
  • DiGiovine, B., Chenoweth, C., Watts, C., Higgins, M.: The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am. J. Respir. Crit. Care Med. 160, 976–981 (1999).

    Higgins M. , 'The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit ' (1999 ) 160 Am. J. Respir. Crit. Care Med. : 976 -981.

    • Search Google Scholar
  • Pittet, D., Wenzel, R. P.: Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch. Intern. Med. 155, 1177–1184 (1995).

    Wenzel R. P. , 'Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths ' (1995 ) 155 Arch. Intern. Med. : 1177 -1184.

    • Search Google Scholar
  • Chaiyakunapruk, N., Veenstra, D. L., Lipsky, B. A., Saint, S.: Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: A meta-analysis. Ann. Intern. Med. 136, 792–801 (2002).

    Saint S. , 'Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: A meta-analysis ' (2002 ) 136 Ann. Intern. Med. : 792 -801.

    • Search Google Scholar
  • Crnich, C., Maki, D.: Are antimicrobial-impregnated catheters effective? When does repetition reach the point of exhaustion? Clin. Infect. Dis. 41, 681–685 (2005).

    Maki D. , 'Are antimicrobial-impregnated catheters effective? When does repetition reach the point of exhaustion? ' (2005 ) 41 Clin. Infect. Dis. : 681 -685.

    • Search Google Scholar
  • Veenstra, D. L., Saint, S., Saha, S., Lumley, T., Sullivan, S. D.: Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: A meta-analysis. JAMA 281, 261–267 (1999).

    Sullivan S. D. , 'Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: A meta-analysis ' (1999 ) 281 JAMA : 261 -267.

    • Search Google Scholar
  • Mermel, L. A.: Prevention of intravascular catheter-related infections. Ann. Intern. Med. 132, 391–402 (2000).

    Mermel L. A. , 'Prevention of intravascular catheter-related infections ' (2000 ) 132 Ann. Intern. Med. : 391 -402.

    • Search Google Scholar
  • Haley, R. W., Culver, D. H., White, J. W., Emori, T. G., Hooton, T. M.: The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am. J. Epidemiol. 121, 182–205 (1985).

    Hooton T. M. , 'The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals ' (1985 ) 121 Am. J. Epidemiol. : 182 -205.

    • Search Google Scholar

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