Factors associated with device-associated health care-associated infections after cardiac surgery: a matched cohort study
Abstract
Background
The study aimed to identify the patient-related and procedure-related factors independently associated with the development of device-associated health care-associated infections (DA-HAIs) in cardiac intensive care unit (CICU), specifically for ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSI), and catheter-associated urinary tract infections (CAUTI).
Methods
We designed a retrospective single-center matched cohort study in CICU at a tertiary referral hospital. The study reviewed all adult patients who underwent cardiac surgery between January 2020, and December 2023. Each patient with a DA-HAI as a case was matched to two control patients admitted to the CICU within ±7 days. Controls had the same catheter in place but did not develop an infection. The matching covariates were: age, weight, sex, count of white blood cell, neutrophil, and lymphocyte. Data were collected from patient records. Independent predictors for DA-HAIs in the CICU were identified through multivariate logistic regression analysis, following an initial univariate screening.
Results
A total of 89 patients with DA-HAIs were matched with 178 controls. Multivariate analysis identified cardiopulmonary bypass (CPB) time >2 hours (adjusted odds ratio (aOR) 7.15, 95% confidence intervals (95% CI) [2.22–23.09]; p = 0.001) and mechanical ventilation >7 days (aOR 13.10, 95% CI [2.09–82.02]; p = 0.006) as strong, independent risk factors. Conversely, a history of valvular surgery (aOR 0.003, 95% CI [0.00–0.03]; p < 0.001), a diagnosis of aortic dissection (aOR 0.06, 95% CI [0.00–0.07]; p < 0.001), and undergoing CABG surgery (aOR 0.053, 95% CI [0.01–0.22]; p < 0.001) were associated with a significantly lower likelihood of infection.
Conclusions
This study identifies prolonged CPB (>2 hours) and mechanical ventilation (>7 days) as key independent risk factors for DA-HAIs in cardiac surgery patients, underscoring that infection prevention should focus on reducing CPB time and promoting early extubation.