Gram-negative rod bacteremia after cardiovascular surgery: Clinical features and prognostic factors.
OBJECTIVE
Our aim was to describe the clinical features and prognostic factors of Gram-negative rod bacteremia (GNRB) after cardiovascular surgery (CVS).


METHODS
This retrospective observational study included adults with GNRB onset within 100 days after CVS at a single institution from April 2004 to May 2013. Clinical data regarding episodes of GNRB were collected from patients' medical charts. Those having polymicrobial bacteremia with a bacterium other than a GNR were excluded.


RESULTS
Among 2017 CVS patients, GNRB occurred in 78. Klebsiella, Pseudomonas aeruginosa, Enterobacter, and Escherichia coli were the most commonly isolated organisms. Graft replacement was the most common surgical procedure in patients with GNRB after CVS (44.9%). Prophylaxis antibiotics were ampicillin/sulbactam (76.9%), and vancomycin (12.8%). The crude 90-day mortality rate was 21.8%, and the mean Acute Physiology and Chronic Health Evaluation II score was 15.6 (range, 3-39). In 34.6% of patients, the same GNR species were isolated from other samples within 30 days of GNRB occurrence. Multivariate analysis indicated that P. aeruginosa bacteremia [odds ratio (OR), 175; confidence interval (CI), 2.40-1270; p = 0.0182], Acute Physiology and Chronic Health Evaluation II scores of ≥ 25 (OR 76.2; CI 1.04-5580; p = 0.0479), and vancomycin for prophylaxis (OR 45.4; CI 1.02-202; p = 0.0488) were significant independent prognostic factors associated with death due to GNRB after CVS.


CONCLUSIONS
Graft replacement was the most common surgical procedure in patients with GNRB after CVS. Empirical antibiotics covering Gram-negative rods including P. aeruginosa should be considered if bacteremia is suspected in unstable patients after CVS.
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: asahata.sayaka@twmu.ac.jp.
Sayaka
S
Tago
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan.
Yuji
Y
Hirai
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan.
Yusuke
Y
Ainoda
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan.
Takahiro
T
Fujita
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan.
Ken
K
Kikuchi
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification* / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents
Gram-negative rod bacteremia; cardiovascular surgery; graft replacement; multivariate analyses; prognostic factor; retrospective study