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Hospital-Acquired Infections After Cardiac Surgery and Current Physician Practices: A Retrospective Cohort Study
Scott O'Keefe1, Kenneth Williams1, Jean-Francois Legare1
1Department of Surgery, Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada.
Insights
Physicians often treat hospital-acquired infections (HAIs) without verification, leading to unnecessary antibiotic use. This practice, common in cardiac surgery patients, may drive antimicrobial resistance.
Area of Science:
- Medical research
- Infectious disease
- Surgical outcomes
Background:
- Physician practices in managing hospital-acquired infections (HAIs) are under-examined.
- Standardizing HAI care is a growing concern.
- This study audits HAI management in cardiac surgery patients.
Purpose of the Study:
- To evaluate physician practices in diagnosing and treating HAIs in cardiac surgery patients.
- To assess verification rates and treatment duration for common HAIs.
- To identify potential drivers of antimicrobial resistance.
Main Methods:
- Retrospective audit of 185 cardiac surgery patients over two months.
- Prevalence assessment of specific HAIs (UTI, pneumonia, surgical site infections, sepsis).
- Analysis of infection verification (microbiology) and antibiotic treatment duration.
Main Results:
- 21% of patients developed at least one HAI; UTI and pneumonia were most common.
- Overall infection verification rate was 50%, with significant variation by infection type.
- Antibiotics were administered for the full course, even with negative cultures or no clear infection evidence.
Conclusions:
- HAIs are frequently treated without microbiological confirmation.
- Antibiotic treatment often continues despite negative results, indicating a lack of evidence-based practice.
- This approach contributes to selective pressure for antimicrobial resistance.
Background:
The management of hospital-acquired infections (HAIs) with respect to physician practices remains largely unexplored despite increasing efforts to standardize care. In the present study, we report findings from a 2-month audit of all patients that have undergone cardiac surgery at a large referral center in Atlantic Canada.
Methods:
All patients who underwent cardiac surgical procedures during May and June 2013 at the Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia were identified. The prevalence of urinary tract infections (UTIs), pneumonia, leg harvest site infections, superficial sternal wound infections, deep sternal wound infections, and sepsis was examined to determine physician approaches in terms of verification rates (microbiology), time of diagnosis and duration of treatment. Continuous variables were compared using Student's t-test and categorical variables were analyzed using Fischer's exact test.
Results:
A total of 185 consecutive patients underwent cardiac surgical procedures, of which 39 (21%) developed at least one postoperative infection. The overall prevalence of infection types, from highest to lowest, was UTI (8%), pneumonia (7%), leg harvest site infection (5%), superficial surgical site infection (4%), and sepsis (2%). There were no deep sternal wound infections. The overall in-hospital mortality rate was 3.8% with a median length of stay (LOS) of 8 days. The overall infection verification rate was 50% (ranged from 100% in sepsis to 10% in leg harvest site infections). In all cases, a full course of antibiotics was administered despite negative microbiology cultures or limited evidence of an actual infection.
Conclusions:
HAIs are commonly treated without being verified and treatment is often not discontinued after negative cultures are received. Our findings highlight the fact that antibiotic treatment is not always supported by evidence, and the effect of this could contribute to increased selective pressure for antimicrobial resistant bacteria.
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