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Frequency, risk factors, and outcome for bacteremia after percutaneous transluminal coronary angioplasty
M H Samore1, M A Wessolossky, S M Lewis
1Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Bacteremia after percutaneous transluminal coronary angioplasty (PTCA) is rare but serious, especially with Staphylococcus aureus. Risk factors include longer procedures and difficult vascular access, indicating increased vascular injury.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Microbiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Bacteremia, the presence of bacteria in the bloodstream, is a potential complication following invasive procedures.
Purpose of the Study:
- To investigate the incidence, outcomes, and risk factors of bacteremia associated with PTCA.
- To categorize bacteremias based on their relationship to the PTCA procedure.
Main Methods:
- A retrospective study of 4,217 PTCA procedures performed between January 1990 and April 1994.
- Patients with positive blood cultures within 7 weeks post-PTCA were identified and bacteremias classified as PTCA-related, unrelated, or indeterminate.
- Statistical analysis was used to identify independent risk factors for PTCA-related bacteremia.
Main Results:
- The incidence of PTCA-related bacteremia was 0.64% (27 cases).
- Septic complications occurred in 0.24% of patients.
- Independent risk factors included procedure duration, multiple catheterizations, difficult vascular access, prolonged arterial sheath use, and congestive heart failure.
- Staphylococcus aureus was the most common pathogen in PTCA-related bacteremia.
Conclusions:
- PTCA-related bacteremia is an infrequent but potentially serious complication.
- Significant morbidity can result, particularly from Staphylococcus aureus infections.
- Risk factors are associated with increased vascular injury or prolonged arterial access.
Abstract:
The objectives of this study were to examine bacteremias after percutaneous transluminal coronary angioplasty (PTCA) with respect to incidence, outcome, and risk factors. Patients undergoing PTCA from January 1990 through April 1994 were studied; during this period a total of 4,217 PTCAs were performed in 3,473 patients. With use of predefined clinical and microbiologic criteria, bacteremias were divided into 3 categories according to the relation to the PTCA procedure: PTCA-related, unrelated, and indeterminate. Ninety-one patients with at least 1 positive blood culture during a 7-week period after PTCA were identified. The bacteremia was classified as unrelated to the PTCA procedure in 32 patients, PTCA-related in 27, and indeterminant in the remaining 32 patients. The attack rate of PTCA-related bacteremia during the 52-month period was 0.64%. The most common organisms causing PTCA-related bacteremia were Staphylococcus aureus (14 patients), coagulase-negative staphylococci (9 patients) and group B streptococci (6 patients). Septic complications, which included femoral artery mycotic aneurysm, septic arthritis, and septic thrombosis, occurred in 10 patients (0.24%). Independent risk factors for PTCA-related bacteremia included duration of procedure (odds ratio [OR] 2.9; p = 0.04), number of catheterizations at the same site (OR 4.0; p = 0.015), difficult vascular access (OR 14.9; p = 0.007), arterial sheath in place > 1 day (OR 6.8; p = 0.025), congestive heart failure (OR 43.3; p = 0.002). Thus, PTCA-related bacteremia is an infrequent complication of PTCA but can be associated with significant morbidity, particularly when the infecting organism is S. aureus. Four of the 5 risk factors for PTCA-related bacteremia appear to correlate directly with increased vascular injury or maintenance of the arterial entry for the procedure.