Infections and outcomes after cardiac surgery—The impact of outbreaks traced to transesophageal echocardiography probes

Abstract

Background Infections are a frequent complication of cardiac surgery. The intraoperative use of transesophageal echocardiography (TEE) may be an underrecognized risk factor for post‐operative infections. The aim of this study was to investigate infection rates and outcomes after cardiac surgery in a nationwide cohort, especially in relation to periods where surface damaged TEE probes were used. Methods This was a retrospective, observational study at Landspitali University Hospital. All consecutive cardiac surgery patients from 1 January 2013 to 31 December 2017 were included. Patients’ charts were reviewed for evidence of infection, post‐operative complications or death. Results During the study period, 973 patients underwent cardiac surgery at Landspitali and 198 (20.3%) developed a post‐operative infection. The most common infections were: Pneumonia (9.1%), superficial surgical site (5.7%), bloodstream (2.8%) and deep sternal wound (1.7%). Risk factors for developing an infection included: The duration of procedure, age, insulin‐dependent diabetes, EuroScore II, reoperation for bleeding and an operation in a period with a surface damaged TEE probe in use. Twenty‐two patients were infected with a multidrug resistant strain of Klebsiella oxytoca, 10 patients with Pseudomonas aeruginosa and two patients developed endocarditis with Enterococcus faecalis. All three pathogens were cultured from the TEE probe in use at respective time, after decontamination. The 30‐day mortality rate in the patient cohort was 3.2%. Conclusions The intraoperative use of surface damaged TEE probes caused two serious infection outbreaks in patients after cardiac surgery. TEE probes need careful visual inspection during decontamination and probe sheaths are recommended.

Endogenous Endophthalmitis Caused by <b><i>Klebsiella pneumoniae</i></b>: A Ten-Year Retrospective Study in Western China

“…We were not surprised at this result. One study found that the bloodstream infection rate was 2.8% after cardiac surgery [28]. Therefore, for some immunocompromised patients, it is not strange for a bloodstream infection to cross the blood – retinal barrier into the eye after cardiac surgery.…”

Endocavity Ultrasound Transducers: Why High-Level Disinfection Is Necessary

“…Two publications in 2019 implemented the TOE transducers in cross-contamination resulting in high mortality [41,42]. Noel et al reported on the outbreak of extended-spectrum B-lactamase (ESBL) producing Enterobacter cloacae among cardio-thoracic surgical patients [41].…”

“…Despite negative swabs of the TOE transducer, its removal from use resulted in the cessation of reported cases. The second study investigated infectious complications following the use of TOE transducers during cardiac surgery [42]. Of the 973 patients, 3.4 % became infected with Klebsiella oxytoca, Pseudomanas aeruginosa or endocarditis with Enterococcus faecalis, with all three pathogens cultured from TOE transducers post-decontamination.…”

“…In the 2011 guidelines from the British Society of Echocardiography, which provided recommendations for transesophageal transducer decontamination, the authors acknowledge the risk of crossinfection with the procedure [39]. Since 2003, there have been multiple published outbreaks of healthcare-associated infections related to the use of TOE transducers that have been reprocessed with LLD [40][41][42][43][44][45]. A patient death from HBV after an examination with an improperly reprocessed TOE transducer resulted in a 2012 medical device alert from the UK Department of Health to ensure that staff decontaminating these devices were trained and fully aware of their responsibilities [40].…”

“…Two publications in 2019 implemented the TOE transducers in cross-contamination resulting in high mortality 41 42 . Noel et al.…”