Post-operative infection treatment in cardiac surgery: current practices and future directions

Surgical site infections (SSIs) are a major complication in surgical patients, particularly after cardiac surgeries, where the risk of postoperative infection ranges from 3.5% to 26.8%. Mediastinitis, severe concerns associated with open cardiac surgery, is linked to extreme deaths, increased medical expenses during hospitalization. We investigated the incidence and features of mediastinitis over a twenty-nine-year period as patient demographics and surgical indications evolved. Escherichia coli bloodstream infections (BSIs) contribute to significant mortality (5%-30%), with factors contributing to death remaining unclear, particularly with the rise of ESBL-producing organisms. Infective endocarditis (IE) is an infection that affects the cardiac endocardial layer, may cause valve vegetation, abscesses, and myopericarditis. Postoperative management requires a clinician with a deep understanding of cardiopulmonary function to address complications promptly. Infections of cardiac implanted electronic devices (CIEDs) are catastrophic, causing significant morbidity and mortality. Among CIED complications, infections drastically affect survival rates, require re-intervention, and lengthen hospital stays. Research shows a 1% infection rate within 12 months after CIED surgery. Acute Kidney Injury (AKI) is a common complication following major cardiac surgery, particularly in procedures involving cardiopulmonary bypass (on-pump). AKI significantly increases the risk of chronic kidney disease, cardiovascular complications, and mortality. Advanced age and pre-existing chronic kidney disease are recognized as key risk factors. Sepsis-induced cardiomyopathy (SICM), though primarily a general complication of severe sepsis, can also occur in post-cardiac surgery patients who develop sepsis as a secondary complication. The absence of standardized diagnostic criteria highlights an important knowledge gap and underscores the need for further research to improve recognition and management in this high-risk group.