Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

Abstract

BackgroundThis study was designed to explore factors associated with the incidence of positive bacterial culture of salvaged red blood cells (sRBCs) recovered with a Cell Saver instrument during cardiac surgery and the impact of such positive outcomes on postoperative infection-related morbidity.MethodsThe cohort study enrolled 204 patients scheduled for cardiac surgery with intraoperative blood cell salvage and retransfusion from July 2021 to July 2022. These patients were stratified into two groups based on intraoperative sRBCs bacterial culture results: culture (+) and culture (−) groups. Preoperative and intraoperative variables were compared between these groups aim to detect possible predictors of positive culture in sRBCs. In addition, differences in postoperative infection-related morbidity and other clinical outcomes were compared between these groups.ResultsOf these patients, 49% were sRBCs culture (+), with Staphylococcus epidermidis as the most commonly identified pathogen. Risk factors independently associated with the risk of positive culture in sRBCs included BMI ≥25 kg/m2, a history of smoking, an operative duration ≥277.5 min, the higher number of staff in the operating room and higher surgical case order. Patients in the sRBCs culture (+) group exhibited a longer average ICU stay [3.5 days (2.0–6.0) vs. 2 days (1.0–4.0), P < 0.01], a longer duration of ventilation [20.45 h (12.0–17.8) vs. 13 h (11.0–17.0, P = 0.02)], underwent more allogeneic blood transfusions, exhibited higher transfusion-related costs [2,962 (1,683.0–5,608.8) vs. 2,525 (1,532.3–3,595.0), P = 0.01], and had higher rates of postoperative infections (22 vs. 9.6%, P = 0.02) as compared to patients in the sRBCs culture (−) group. In addition, culture (+) in sRBCs was an independent risk factor for postoperative infection (OR 2.62, 95% CI 1.16–5.90, P = 0.02).ConclusionStaphylococcus epidermidis was the most common pathogen detected in sRBCs in the culture (+) group in this study, identifying it as a potential driver of postoperative infection. Positive sRBCs culture may contribute to postoperative infection and its incidence was significantly associated with patient BMI, history of smoking, operative duration, the number of staff in the operating room and surgical case order.

The effectiveness of cell salvage in extracorporeal circulation surgeries in relation to use of health resources after use: A systematic review and meta-analysis

“…Similarly, Khabori et al [ 62 ], found that the use of Cell Salvage did not decrease the transfusion rate [OR: 0.69; 95 % CI: 0.48–1.00). Continuing in the same line, the results of Zhou et al [ 63 ], indicated that patients who underwent surgery using Cell Salvage underwent more allogeneic transfusions and had a longer stay in the ICU, resulting in higher healthcare costs.…”

“…Nevertheless, the results are inconclusive depending on the aspect evaluated, and controversy exists. While several studies suggest that the use of Cell Salvage substantially reduces allogeneic blood transfusions [ [54] , [55] , [56] , [57] , [58] , [59] , [60] ], other authors argue the opposite [ [61] , [62] , [63] ]. In this regard, according to a study by Stoneham et al [ 61 ], patients operated on using Cell Salvage had to be transfused with other allogeneic components within the first 24 h postoperatively.…”