Pathogenic characteristics of bloodstream infection after cardiovascular surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Chao , WANG Yuanfang , DENG Jing , DENG Jielun ,  KANG Mei

Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

KANG Mei, Email: kangmei@sina.com

Keywords：

Cardiovascular surgery; bloodstream infection; pathogen

DOI：

10.7507/1007-4848.201703034

Video：

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Objective To analyze the characteristics of pathogens causing bloodstream infection (BSI) after cardiovascular surgery, and provide instructions for prevention and treatment of such kind of disease. Methods A retrospective investigation of clinical and pathogenic data of the patients suffering from BSI after cardiovascular surgery in West China Hospital of Sichuan University from January 2015 to December 2016 was performed. There were 61 patients with 36 males and 25 females at average age of 48.2±17.1 years. A percentage of 65.6% (40/61) of the underlying diseases was rheumatic heart disease. Results Sixty-five strains were isolated from the blood culture specimens of the 61 patients. Gram-positive bacteria, gram-negative bacteria and fungi isolates accounted for 56.9% (37/65), 35.4% (23/65), and 7.7% (5/65), respectively. Among these isolates, Streptococcus spp. was predominant (19/65, 29.2%), followed by Staphylococcus epidermidis (8/65, 12.3%), Staphylococcus aureus (6/65, 9.2%), Acinetobacter calcoaceticus- A. baumannii (5/65, 7.7%) and Escherichia coli (5/65, 7.7%). The resistance rate of Streptococcus spp. to erythromycin and clindamycin was 73.4% (14/19) and 63.2% (12/19), while its resistance to cefepime, vancomycin or linezolid was not observed. Staphylococcus spp. showed the resistance rate of 71.4% (10/14) to oxacillin. All of A. calcoaceticus-A. baumannii isolates were multidrug resistant (5/5, 100.0%), and 80.0% (4/5) of them were resistant to imipenem. The isolates producing extended spectrum beta-lactamase accounted for 80.0% (4/5) of E. coli. Conclusion Streptococcus spp. was the common pathogen causing BSI after cardiovascular surgery. Staphylococcus spp. and gram-negative bacilli show high resistance.

Citation： HE Chao, WANG Yuanfang, DENG Jing, DENG Jielun, KANG Mei. Pathogenic characteristics of bloodstream infection after cardiovascular surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(6): 435-438. doi: 10.7507/1007-4848.201703034 Copy

1.	Chen LF, Arduino JM, Sheng S, et al. Epidemiology and outcome of major postoperative infections following cardiac surgery: risk factors and impact of pathogen type. Am J Infect Control, 2012, 40(10): 963-968.
2.	Conterno LO, Toni SM, Konkiewitz RG, et al. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericordia de Marilia. Rev Bras Cir Cardiovasc, 2014, 29(2): 167-176.
3.	Grisaru-Soen G, Paret G, Yahav D, et al. Nosocomial infections in pediatric cardiovascular surgery patients: a 4-year survey. Pediatr Crit Care Med, 2009, 10(2): 202-206.
4.	Sahu MK, Siddharth B, Choudhury A, et al. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit. Ann Card Anaesth, 2016, 19(2): 281-287.
5.	CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 26th ed. CLSI Supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2016.
6.	Kortekaas KA, Lindeman JH, Versteegh MI, et al. Preexisting heart failure is an underestimated risk factor in cardiac surgery. Neth Heart J, 2012, 20(5): 202-207.
7.	Willems A, Van Lerberghe C, Gonsette K, et al. The indication for perioperative red blood cell transfusions is a predictive risk factor for severe postoperative morbidity and mortality in children undergoing cardiac surgery. Eur J Cardiothorac Surg, 2014, 45(6): 1050-1057.
8.	Lagrost L, Girard C, Grosjean S, et al. Low preoperative cholesterol level is a risk factor of sepsis and poor clinical outcome in patients undergoing cardiac surgery with cardiopulmonary bypass. Crit Care Med, 2014, 42(5): 1065-1073.
9.	李军民, 胡云芝, 冯陆, 等. 心脏术后医院感染的病原菌分布与耐药性分析. 中华医院感染学杂志, 2015, 25(1): 72-74.
10.	Suzuki H, Hase R, Otsuka Y, et al. Bloodstream infections caused by Streptococcus anginosus group bacteria: A retrospective analysis of 78 cases at a Japanese tertiary hospital. J Infect Chemother, 2016, 22(7): 456-460.
11.	Ballard MS, Schonheyder HC, Knudsen JD, et al. The changing epidemiology of group B streptococcus bloodstream infection: a multi-national population-based assessment. Infect Dis (Lond), 2016, 48(5): 386-391.
12.	Sunkara B, Bheemreddy S, Lorber B, et al. Group B Streptococcus infections in non-pregnant adults: the role of immunosuppression. Int J Infect Dis, 2012, 16(3): e182-186.
13.	Trethon A, Prinz G, Varga A, et al. Characteristics of nosocomial bloodstream infections at a Hungarian cardiac surgery centre. Acta Microbiol Immunol Hung, 2012, 59(2): 271-283.
14.	Kohler P, Sommerstein R, Schonrath F, et al. Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery. Am J Infect Control, 2015, 43(7): e33-38.
15.	Mastoraki A, Kriaras I, Douka E, et al. Methicillin-resistant Staphylococcus aureus preventing strategy in cardiac surgery. Interact Cardiovasc Thorac Surg, 2008, 7(3): 452-456.
16.	Pierri MD, Crescenzi G, Capestro F, et al. risk factors and impact on clinical outcome of multidrug-resistant acinetobacter baumannii acquisition in cardiac surgery patients. J Cardiothorac Vasc Anesth, 2016, 30(3): 680-686.
17.	Jaworski R, Haponiuk I, Steffens M, et al. Colonization of multidrug resistant pathogens in a hybrid pediatric cardiac surgery center. Arch Med Sci, 2016, 12(3): 639-644.

1. Chen LF, Arduino JM, Sheng S, et al. Epidemiology and outcome of major postoperative infections following cardiac surgery: risk factors and impact of pathogen type. Am J Infect Control, 2012, 40(10): 963-968.
2. Conterno LO, Toni SM, Konkiewitz RG, et al. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericordia de Marilia. Rev Bras Cir Cardiovasc, 2014, 29(2): 167-176.
3. Grisaru-Soen G, Paret G, Yahav D, et al. Nosocomial infections in pediatric cardiovascular surgery patients: a 4-year survey. Pediatr Crit Care Med, 2009, 10(2): 202-206.
4. Sahu MK, Siddharth B, Choudhury A, et al. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit. Ann Card Anaesth, 2016, 19(2): 281-287.
5. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 26th ed. CLSI Supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2016.
6. Kortekaas KA, Lindeman JH, Versteegh MI, et al. Preexisting heart failure is an underestimated risk factor in cardiac surgery. Neth Heart J, 2012, 20(5): 202-207.
7. Willems A, Van Lerberghe C, Gonsette K, et al. The indication for perioperative red blood cell transfusions is a predictive risk factor for severe postoperative morbidity and mortality in children undergoing cardiac surgery. Eur J Cardiothorac Surg, 2014, 45(6): 1050-1057.
8. Lagrost L, Girard C, Grosjean S, et al. Low preoperative cholesterol level is a risk factor of sepsis and poor clinical outcome in patients undergoing cardiac surgery with cardiopulmonary bypass. Crit Care Med, 2014, 42(5): 1065-1073.
9. 李军民, 胡云芝, 冯陆, 等. 心脏术后医院感染的病原菌分布与耐药性分析. 中华医院感染学杂志, 2015, 25(1): 72-74.
10. Suzuki H, Hase R, Otsuka Y, et al. Bloodstream infections caused by Streptococcus anginosus group bacteria: A retrospective analysis of 78 cases at a Japanese tertiary hospital. J Infect Chemother, 2016, 22(7): 456-460.
11. Ballard MS, Schonheyder HC, Knudsen JD, et al. The changing epidemiology of group B streptococcus bloodstream infection: a multi-national population-based assessment. Infect Dis (Lond), 2016, 48(5): 386-391.
12. Sunkara B, Bheemreddy S, Lorber B, et al. Group B Streptococcus infections in non-pregnant adults: the role of immunosuppression. Int J Infect Dis, 2012, 16(3): e182-186.
13. Trethon A, Prinz G, Varga A, et al. Characteristics of nosocomial bloodstream infections at a Hungarian cardiac surgery centre. Acta Microbiol Immunol Hung, 2012, 59(2): 271-283.
14. Kohler P, Sommerstein R, Schonrath F, et al. Effect of perioperative mupirocin and antiseptic body wash on infection rate and causative pathogens in patients undergoing cardiac surgery. Am J Infect Control, 2015, 43(7): e33-38.
15. Mastoraki A, Kriaras I, Douka E, et al. Methicillin-resistant Staphylococcus aureus preventing strategy in cardiac surgery. Interact Cardiovasc Thorac Surg, 2008, 7(3): 452-456.
16. Pierri MD, Crescenzi G, Capestro F, et al. risk factors and impact on clinical outcome of multidrug-resistant acinetobacter baumannii acquisition in cardiac surgery patients. J Cardiothorac Vasc Anesth, 2016, 30(3): 680-686.
17. Jaworski R, Haponiuk I, Steffens M, et al. Colonization of multidrug resistant pathogens in a hybrid pediatric cardiac surgery center. Arch Med Sci, 2016, 12(3): 639-644.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Pathogenic characteristics of bloodstream infection after cardiovascular surgery

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