title: The role of patient's profile and allogeneic blood transfusion in development of post-cardiac surgery infections: a retrospective study.
abstract: OBJECTIVE
  We aimed to investigate the association of patient characteristics and allogeneic blood transfusion products in development of post-cardiac surgery nosocomial infections.
  
  
  METHODS
  This retrospective study was conducted in 7888 patients undergoing cardiac surgery with median sternotomy and cardiopulmonary bypass. Multivariable logistic regression analysis was used for independent effect of variables on infections.
  
  
  RESULTS
  A total of 970 (12.3%) patients developed one or several types of postoperative infections. Urinary (n = 351, 4.4%) and pulmonary tract infections (n = 478, 6.1%) occurred more frequently than sternal wound infections (superficial: n = 102, 1.3%, deep: n = 72, 0.9%) and donor site infections (n = 61, 0.8%). Interventions, including valve replacement (P = 0.002) and coronary artery bypass grafting combined with valve replacement (P = 0.012), were associated with increased risk of several types of postoperative infections. Patients' profiles changed substantially over the years; morbid obesity (P = 0.019), smoking (P = 0.001) and diabetes mellitus (P = 0.001) occur more frequently nowadays. Furthermore, surgical site infections showed to be related to morbid obesity (P < 0.001) and higher risk stratification (P = 0.031). Smoking (P < 0.001) and chronic obstructive pulmonary disease (P < 0.001) were related to pulmonary tract infections. In addition, diabetic patients developed more sepsis (P = 0.003) and advanced age was associated with development of urinary tract infections (P < 0.001). Even after correcting for other factors, blood transfusion was associated with all types of postoperative infection (P < 0.001). This effect remained present in both leucocyte-depleted and non-leucocyte-depleted transfusion.
  
  
  CONCLUSIONS
  Our data showed that post-cardiac surgery infections occur more frequently in patients with predetermined risk factors. The amount of blood transfusions was integrally related to every type of postoperative infection.
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
authors.forename: Nousjka P A
authors.initials: NP
authors.lastname: Vranken
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands p.weerwind@maastrichtuniversity.nl.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Weerwind
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
authors.forename: Paul J C
authors.initials: PJ
authors.lastname: Barenbrug
authors.affiliation: Department for Health Evidence, Section Biostatistics, Radboud University Medical Centre, Nijmegen, Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: Teerenstra
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
authors.forename: Yuri M
authors.initials: YM
authors.lastname: Ganushchak
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D015897:Comorbidity; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D056346:Sternotomy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality
keywords: Blood transfusion; Cardiopulmonary bypass; Nosocomial infection; Patient characteristics