In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

Financial impact of nosocomial infections on surgical patients in an eastern Chinese hospital: a propensity score matching study

This study, conducted at Zhejiang Taizhou Hospital, China, aimed to examine the financial impact of nosocomial infections on surgical patients. A retrospective case-control study using propensity score matching was conducted over a 9-month period from January to September 2022. The study included 729 surgical patients with nosocomial infections and 2187 matched controls without infections. Medical expenses, length of hospitalization and total economic burden were compared between the two groups. The rate of nosocomial infections in surgical cases was 2.66%. The median hospitalization cost for patients with nosocomial infections was US$8220, compared with US$3294 for controls. The overall additional medical expenditure attributable to nosocomial infections amounted to US$4908. Notable median differences were observed between cases with nosocomial infections and controls in terms of total hospitalization cost, nursing services, medication, treatment, materials, test fees and blood transfusion fees. In each age group, medical costs for patients with nosocomial infections were more than twice those of controls. Additionally, hospital stays for surgical patients with nosocomial infections were, on average, 13 days longer compared with controls. These findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on patients and the healthcare system.

Impact of Post-Operative Infection after CABG on Long-Term Survival

Coronary artery bypass grafting (CABG) is one of the most common cardiac surgical procedures. It is commonly known that post-operative infection has a negative impact on the patient's short-term treatment outcomes and long-term prognosis. The aim of the present study was to assess the impact of perioperative infection on 5-year and 10-year survival in patients undergoing elective on-pump CABG surgery. The present prospective observational study was carried out between 1 July 2010 and 31 August 2012 among patients undergoing cardiac surgery at our centre. Infections were identified according to the ECDC definitions. We initially assessed the incidence of infection and its relationship with the parameters analysed. We then analysed the effect of particular parameters, including infection, on 5-year and 10-year survival after surgery. We also analysed the impact of particular types of infection on the risk of death within the period analysed. The significant risk factors for reduced survival were age (HR 1.05, CI 1.02-1.07), peripheral artery disease (HR 1.99, CI 1.28-3.10), reduced LVEF after surgery (HR 0.96, CI 0.94-0.99), post-operative myocardial infarction (HR 1.45, CI 1.05-2.02) and infection (HR 3.10, CI 2.20-4.28). We found a strong relationship between post-operative infections and 5-year and 10-year mortality in patients undergoing CABG. Pneumonia and BSI were the only types of infection that were found to have a significant impact on increased long-term mortality after CABG surgery.

Impact of pretransplant bloodstream infection on clinical outcomes after heart transplantation

BACKGROUND

Active bloodstream infection (BSI) is a contraindication for heart transplantation (HT). However, some critical patients with BSI may undergo HT as a life-saving procedure. We aimed to investigate the impact of pretransplant BSI on the clinical outcomes after HT.

METHODS

We enrolled 511 consecutive patients who underwent HT between 1999 and 2019. Patients were divided into two groups based on the presence of BSI within 30 days preoperatively. Forty-three patients (8.4%) with BSI who were clinically stable and had no metastatic infection were considered for HT on an individual basis. In-hospital mortality, incidence of early postoperative BSI, length of postoperative hospital stays, and long-term survival were compared between the groups. Logistic and Cox regression analyses were performed to identify risk factors for in-hospital and 1-year mortality.

RESULTS

Patients with pretransplant BSI had a high incidence of previous cardiopulmonary resuscitation, pretransplant ventilator use, mechanical circulatory support use, renal replacement therapy, United Network for Organ Sharing status 1A, and a prolonged preoperative hospital waiting period. The in-hospital mortality rate was higher in patients with pretransplant BSI (21% versus 12%, p = 0.081), and the mortality rate was very high (33.3%) for those with BSI 0-15 days before HT. In addition, patients with pretransplant BSI had a significantly longer postoperative hospital stay than patients in the control group. However, long-term survival was similar in both groups.

CONCLUSIONS

Although pretransplant BSI was associated with higher in-hospital mortality and prolonged postoperative hospital stay, patients who survived the early period had a similar long-term prognosis. This article is protected by copyright. All rights reserved.

Distribution and resistance of pathogens in infected patients within 1 year after heart transplantation

BACKGROUND

Infection is a major cause of morbidity and mortality after heart transplantation (HT). However, there have been few data on clinical manifestation, distribution, and resistance of pathogens in the infected population of heart transplant recipients.

METHODS

We conducted a single-center retrospective study on patients who underwent HT in Wuhan Union Hospital from August 3, 2012 to July 30, 2016. Risk factors for infections that occur within 1 year after HT were investigated by multivariable logistic regression analysis.

RESULTS

Among 299 patients, 147 patients (49.2%) confirmed infection. The most common site of infection was the respiratory system. A total of 259 pathogens were detected in 147 patients (49.2%) with infection after HT. In all, 64 multidrug-resistant (MDR) bacteria were detected in infected patients within 1 year after HT, the most common MDR bacteria were extended-spectrum β-lactamases (ESBL) Klebsiella pneumonia and methicillin-resistant Staphylococcus aureus (MRSA). In the multivariable model, diabetes (OR 3.273 [95%CI, 1.748-6.130], and p < .001) and antibiotics treatment within 1 month before transplant (OR 1.860 [95%CI, 1.093-3.166], and p = .022) were significantly associated with infections within 1 year after HT.

CONCLUSIONS

This study confirmed the high rate of infections within 1 year after HT. Diabetes and antibiotics treatment within 1 month before transplant were independent risk factors for infections within 1 year after HT.