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Nosocomial infections after off-pump coronary artery bypass surgery: frequency, characteristics, and risk factors

^a Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
^b Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
^c Intensive Care Unit, Henry Dunant Hospital, Athens, Greece
^d Department of Medicine, University of Crete, School of Medicine, Heraklion, Crete
^e Department of Medicine, Henry Dunant Hospital, Athens, Greece
^f Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA

*Corresponding author. 9 Neapoleos Street, Marousi 151 23, Greece. Tel.: +30-694-6110000; fax: +30-210-6839605.

E-mail address: m.falagas{at}aibs.gr (M.E. Falagas).

We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period June 2004–October 2005 at Henry Dunant Hospital, Athens, Greece. C-reactive protein (CRP) and procalcitonin were assayed from 222 patients preoperatively, and 1–3 days following OPCABG. Variables independently associated with infection were identified by a multivariable logistic regression model. Eighteen of 360 (5%) patients developed postoperative infections; 1.7% developed superficial wound infection, 1.4% pneumonia, 1.1% bacteremia, 0.3% mediastinitis, and 0.3% intra-aortic balloon pump related infection. The mean increase of CRP and procalcitonin levels in the first two or three days, respectively, after surgery was significantly higher (P<0.05) in patients with infection. Independent risk factors of infection (P<0.05) were history of major nervous system disorder, left ventricular heart failure preoperatively, emergent operation, transfusions of red blood cells during ICU stay, and duration of central venous catheter placement. The identification of risk factors for infection in combination with the appropriate evaluation of the increased CRP and procalcitonin values may help clinicians for the early diagnosis of infection after OPCABG.

Key Words: Postoperative complications; Mortality; Procalcitonin; C-reactive protein; Sternal wound cultures; Predictive value