Professional paper

FREQUENCY, RISK FACTORS, PREVENTION AND TREATMENT OF NOSOCOMIAL INFECTION IN ADULT CARDIOSURGICAL PATIENTS AT INTENSIVE CARE UNIT, RIJEKA UNIVERSITY HOSPITAL CENTER IN 2015

DINO MIJATOVIĆ ; Rijeka University Hospital Centre, Department of Anesthesiology and Intensive Care, Rijeka, Croatia
DRAGANA ANDRIĆ ; Division of Cardiosurgical Intensive Care, Rijeka, Croatia
VALNEA ČIKADA ; Pula General Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Pula, Croatia
JOSIP MILANOVIĆ ; Pula General Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Pula, Croatia
MAJA ABRAM ; Rijeka University Hospital Centre, University Department of Clinical Microbiology, Rijeka, Croatia
ŽELJKO ŽUPAN ; Division of Cardiosurgical Intensive Care, Rijeka, Croatia

Abstract

The aim of this retrospective study was to assess the incidence, risk factors and effi cacy of preventive measures and perioperative antibiotic prophylaxis in 392 adult cardiac surgery patients treated early postoperatively in the Intensive Care Unit (ICU), Rijeka University Hospital Centre, Rijeka, Croatia, between January 1 and December 31, 2015. The following criteria for nosocomial infection were analyzed: patients with positive microbiological cultures routinely taken at ICU (urine culture, swab, ventilator-associated tracheobronchitis); patients with sequential organ failure assessment (SOFA) score ≥6; patients
with positive microbiological cultures 24 hours after admission to ICU due to hemodynamic instability, clinical pulmonary infection score (CPIS score) 1-6 or signs of sternal infection; and patients with negative microbiological cultures but with CPIS score >6. Nosocomial infection occurred in 10% of patients and mortality was 7.5%. The following risk factors for development of nosocomial infection in these patients were identifi ed in the study: positive preoperative microbiological cultures, invasive mechanical ventilation longer than 72 hours, theatre rocedures longer than 240 minutes, postoperative ICU treatment longer than 72 hours, persistent hemodynamic instability 24 hours after postoperative admission, application of extracorporeal circulation, and emergency operations. Respiratory tract infections were the most common nosocomial infections; there was high correlation with positive nasal swabs confi rmed preoperatively in almost 6% of patients having undergone elective surgery, with Staphylococcus aureus as the most frequent isolate. Results of our study pointed to the need of preoperative eradication of nasal carriage of bacteria by topical application of mupirocin in patients undergoing elective cardiac surgery and urinary infection treatment until negative culture. Also, the doses of perioperative antibiotic prophylaxis should be administered according to body weight, level of bleeding, duration of operating procedure, and use
of extracorporeal circulation.

Keywords

adult cardiac surgery patient; early postoperative period; intensive care unit; nosocomial infections; risk fac

Hrčak ID:

197721

URI

https://hrcak.srce.hr/197721

Publication date:

3.4.2018.

Article data in other languages: croatian

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