Transfusion and blood stream infections after coronary surgery

Abstract

The aim of this study was to evaluate the impact of blood transfusion on bloodstream infections. This study included 2764 patients who underwent isolated coronary artery bypass grafting. Blood cultures were drawn in 27.9% of patients and were positive in 3.5% of them. Blood transfusion before blood cultures were drawn (4.7% vs 1.2%, odds ratio 3.75, 95% confidence interval 1.11-12.67) and deep sternal wound infection/mediastinitis (20.0% vs 2.8%, odds ratio 7.43, 95% confidence interval 2.72-20.32) were independent predictors of a positive postoperative blood culture. Positive blood culture increased the risk of 5-year mortality (among patients with blood cultures drawn: 44.7% vs 19.6%, adjusted hazard ratio 2.10, 95% confidence interval 1.18-3.71). Exposure to blood products may increase the risk of bloodstream infection after cardiac surgery. Positive blood cultures after coronary artery bypass grafting are associated with poor late survival. These findings require validation in prospective studies.

Bloodstream infections during post-cardiotomy extracorporeal membrane oxygenation: Incidence, risk factors, and outcomes

“…Patients experiencing severe bleeding while on ECMO are treated with large doses of RBCs, FFP, and PLTs. Massive transfusions are a known risk factor for infections in cardiac surgery both in pediatric 19 and adult 20 patients. In addition, they have an increased manipulation of the infusion lines and more often require surgical re-explorations, which are again risk factors for infections.…”

Long-term morbidity and mortality following bloodstream infection: A systematic literature review

“…expected as studies of this type define different criteria for the included pathogen, the selection of the matched population and the degree and measurement of comorbidity. All studies with the exception of one (25) have attempted to account for age, hospitalisation, co-morbid disease states by matching and adjustments in analysis. A significant increase in mortality was seen in six of the seven studies when measured at one year.…”

“…The seven studies which assessed mortality evaluated this outcome in comparison to matched controls, which were non-BSI hospital controls in four studies and population controls in the other three. All studies with the exception of one (25) included adjustments for co-morbid disease with this most commonly measured as a Charlson index or score (26).…”

“…Reference to the cause of death was made in three of the seven studies reporting mortality (18,23,25,27).…”

Predictive risk factors for postoperative pneumonia after heart transplantation

“…The association of increased incidence of POP and transfusion or reoperation for bleeding are additional arguments to explain the blood-forming origin of POP [10] and this unusual high rate of Enterobacteriaceae and Pseudomonas aeruginosa in POP after HTx. Transfusion per se is an additional process that is known to increase the rate of postoperative infections after the first transfusion of packed red blood cells [22] and to increase 28-day mortality [23]. The modulation of the immune response by transfusion may promote the development of postoperative infectious complications [24,25].…”