Multidrug-Resistant Bacterial Infection in Adult Patients Following Cardiac Surgery: Clinical Characteristics and Risk Factors

Abstract

Abstract Background The emergence and prevalence of infections with multidrug-resistant organisms (MDROs) pose great challenges for clinical anti-infective therapy. Cardiac surgery is characterized by high surgical difficulty, strict aseptic operation requirements, and long operation time. Previous research data on postoperative MDR bacterial infection are limited. Therefore, it is of great clinical significance to understand the clinical characteristics of adult patients with MDRO infection after cardiac surgery and the risk predictors of infection. Methods The complete medical records of adult patients with MDR bacterial infection after cardiac surgery from January 2018 to October 2021 were collected to understand the clinical characteristics of MDR bacterial infection in a specific environment and to evaluate the risk predictors of MDR bacterial infection after surgery. Results From January 2018 to October 2021, a total of 176 adult patients suffered from MDR bacterial infection after cardiac surgery. A total of 306 strains of MDR bacteria were detected in clinical samples, and 97 patients (55.1%) suffered from multiple bacterial infections. The most common bacterial distribution was Acinetobacter baumannii (114/306, 37.3%). The main clinical manifestations were lower respiratory tract infection (51/176, 29.0%), followed by bloodstream infection (12/176, 6.8%), mediastinal infection (2/176, 1.1%), urinary tract infections (2/176, 1.1%) and skin soft tissue infections (1/176, 0.6%). Preinfection exposure to vancomycin (P<0.001), combined antibiotic administration (P<0.001), and glucocorticoid administration (P=0.029) were associated with prolonged hospital stay (P=0.003) and ICU stay (P < 0.001). The presence of preoperativehypoalbuminemia (P=0.003) was a risk factor for MDR bacterial infection after cardiac surgery. Undergoing a second surgery during hospitalization (OR=1.91, 95% CI=1.131-3.425, P=0.015) and preoperative exposure to linezolid (OR=3.70, 95% CI=1.291-10.629, P=0.015) were independent risk factors for developing MDR bacterial infections. Conclusion The incidence of MDR bacterial infection is high in adult patients undergoing cardiac surgery, and these organisms are highly resistant to commonly used antibiotics. Therefore, it is of great importance to strengthen perioperative management of inpatients in cardiac surgery, achieve early identification of risk factors for postoperative MDR bacterial infection, and ensure containment of the occurrence and spread of drug-resistant bacterial infection.