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Mortality Associated With Surgical Site Infections Following Cardiac Surgery: Insights From the International Id-Iri Study Publisher



Erdem H1, 2 ; Ankarali H3 ; Altawfiq JA4, 5 ; Angamuthu K6 ; Piljic D7 ; Umihanic A7 ; Dayyab F2 ; Karamanlioglu D8 ; Pekok AU9 ; Caglasonmezer M10 ; Elkholy A11 ; Gad MA11 ; Velicki L12 ; Akyildiz O13 Show All Authors
Authors
  1. Erdem H1, 2
  2. Ankarali H3
  3. Altawfiq JA4, 5
  4. Angamuthu K6
  5. Piljic D7
  6. Umihanic A7
  7. Dayyab F2
  8. Karamanlioglu D8
  9. Pekok AU9
  10. Caglasonmezer M10
  11. Elkholy A11
  12. Gad MA11
  13. Velicki L12
  14. Akyildiz O13
  15. Altindis M14
  16. Baskolelik D15
  17. Erturksengel B16
  18. Kara I17
  19. Kahraman U18
  20. Ozdemir M19
  21. Caskurlu H20
  22. Cag Y20
  23. Alkhalifa A7
  24. Hakamifard A21, 22
  25. Batinjan MKG12
  26. Tahir M23
  27. Tukenmeztigen E16
  28. Zajkowska J24
  29. Elkholy J25
  30. Gasparovic H26
  31. Filiz M1
  32. Gul O27
  33. Tehrani HA28
  34. Doyukkartal E29
  35. Aybarbilir Y8
  36. Kahraman H29
  37. Mikulic H30
  38. Dayan S31
  39. Cascio A32
  40. Yurdakul ES33
  41. Colkesen F34
  42. Karahangil K35
  43. Espinosa A2
  44. Rahimi BA36
  45. Vangel Z37
  46. Fasciana T38
  47. Giammanco A38
Show Affiliations
Authors Affiliations
  1. 1. Turkish Health Sciences University, Gulhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
  2. 2. Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
  3. 3. Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
  4. 4. Specialty Internal Medicine and Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
  5. 5. Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, United States
  6. 6. Department of Infectious Diseases, Almana General Hospitals, Dammam, Saudi Arabia
  7. 7. University Clinical Center Tuzla, Department of Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina
  8. 8. Etlik City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
  9. 9. Department of Infectious Diseases, VM Medical Park, Pendik Hospital, Istanbul, Turkey
  10. 10. Hacettepe University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
  11. 11. Cairo University, Faculty of Medicine, Clinical and Chemical Pathology Department, Cairo, Egypt
  12. 12. Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia and Institute of Cardiovascular Disease Vojvodina, Sremska Kamenica, Serbia
  13. 13. Acibadem Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
  14. 14. Sakarya University, Faculty of Medicine, Department of Microbiology, Sakarya, Turkey
  15. 15. Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
  16. 16. Marmara University Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
  17. 17. Sakarya University, Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya, Turkey
  18. 18. Ege University, Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Turkey
  19. 19. Necmettin Erbakan University, Faculty of Medicine, Department of Microbiology, Konya, Turkey
  20. 20. Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
  21. 21. Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  22. 22. Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  23. 23. Department of Medicine, Federal General Hospital, Islamabad, Pakistan
  24. 24. Medical University in Bialystok, Department of Infectious Diseases and Neuroinfections, Bialystok, Poland
  25. 25. Cairo University Hospital, Department of Anesthesia, Pain Management, Cairo, Egypt
  26. 26. University Hospital Centre Zagreb, University of Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
  27. 27. Sisli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
  28. 28. Shahid Beheshti University of Medical Sciences, Department of Hematology and Medical Oncology, Tehran, Iran
  29. 29. Eskisehir Osmangazi University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
  30. 30. SKB Mostar, Department of Cardiac Surgery, Mostar, Bosnia and Herzegovina
  31. 31. Dicle University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Turkey
  32. 32. Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
  33. 33. Turkish Health Sciences University, Gulhane School of Medicine, Department of Medical History and Ethics, Ankara, Turkey
  34. 34. Turkish Health Sciences University, Konya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology Konya, Turkey
  35. 35. Istanbul Medipol University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
  36. 36. Kandahar University Faculty of Medicine, Department of Pediatrics, Kandahar, Afghanistan
  37. 37. PHI UC State Cardiac Surgery, Department of Cardiac Surgery, Skopje, North Macedonia
  38. 38. Department of Health Promotion, Maternal Childhood, Internal Medicine of Excellence G. D'Alessandro, University of Palermo, Palermo, Italy

Source: IJID Regions Published:2025


Abstract

Objectives: Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods: Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results: Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions: To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management. © 2025 The Authors