ANTIMICROBIAL RESISTANCE AND CLINICAL OUTCOMES OF BLOODSTREAM INFECTIONS IN A CARDIOVASCULAR SURGERY DEPARTMENT

Öz

Objective: Bloodstream infections (BSIs) following cardiovascular surgery and cardiovascular interventions are major postoperative complications associated with substantial morbidity and mortality. Although antimicrobial resistance (AMR) has become an increasingly important global public health concern, this study aimed to clarify its impact on clinical outcomes in patients who develop postoperative BSIs. Method: This retrospective study included 139 adult patients who developed BSIs after cardiovascular surgery or cardiovascular interventions at a tertiary referral center. The associations of multidrug resistance (MDR), carbapenem resistance (CR), methicillin resistance, and penicillin resistance with mortality, hospital length of stay (LOS), intensive care unit (ICU) stay, and mechanical ventilation duration were evaluated. Independent predictors of mortality were identified using multivariable logistic regression analysis. Results: The overall mortality rate was 30.9%. Gram-negative pathogens accounted for 56.8% of BSIs and Gram-positive pathogens for 43.2%. Staphylococcus species were the most frequently isolated pathogens (33.8%), comprising other Staphylococcus species (26.6%) and Staphylococcus aureus (7.2%), followed by Klebsiella pneumoniae (21.6%) and Acinetobacter baumannii (12.9%). Neither MDR nor CR was significantly associated with mortality (p>0.05). However, among patients with Gram-negative BSIs, carbapenem-resistant isolates were associated with significantly longer hospital, and ICU stays than carbapenem-susceptible isolates (both p=0.006). Univariable analyses showed significant associations between mortality and Gram-negative BSIs, diabetes mellitus, hypertension, and surgical procedure type. Multivariable analysis identified prolonged cardiopulmonary bypass (CPB) duration (OR=1.015, 95% CI: 1.005–1.025; p=0.003) and Gram-negative BSI (OR=3.938, 95% CI: 1.225–12.659; p=0.021) as independent predictors of mortality. Conclusion: AMR was associated with greater healthcare resource utilization, particularly prolonged hospital and ICU stays, but was not significantly associated with mortality in this cohort. In contrast, Gram-negative BSIs and prolonged CPB duration were independent predictors of mortality.

Anahtar Kelimeler

• Cardiovascular Surgery Procedures
• Bacteremia
• Drug Resistance
• Carbapenem Resistance
• Cardiopulmonary Bypass

KARDİYOVASKÜLER CERRAHİ KLİNİĞİNDE KAN DOLAŞIMI ENFEKSİYONLARINDA ANTİMİKROBİYAL DİRENÇ VE KLİNİK SONUÇLAR

Öz

Amaç: Kalp cerrahisi ve kardiyovasküler girişimler sonrasında ortaya çıkan kan dolaşımı enfeksiyonları (KDE), yüksek morbidite ve mortalite ile ilişkili önemli postoperatif komplikasyonlardır. Antimikrobiyal direnç (AMR) giderek artan küresel bir halk sağlığı sorunu haline gelmiş olsa da, bu çalışma postoperatif KDE gelişen hastalarda AMR’nin klinik sonuçlar üzerindeki etkisini ortaya koymayı amaçlamıştır. Yöntem: Bu retrospektif çalışmaya, üçüncü basamak bir merkezde kardiyovasküler cerrahi veya kardiyovasküler girişimler sonrasında KDE gelişen 139 erişkin hasta dahil edildi. Çoklu ilaç direnci (MDR), karbapenem direnci (CR), metisilin direnci ve penisilin direncinin hastane içi mortalite, hastanede kalış süresi (LOS), yoğun bakım ünitesinde (YBÜ) kalış süresi ve mekanik ventilasyon süresi ile ilişkisi değerlendirildi. Hastane içi mortalitenin bağımsız belirleyicileri çok değişkenli lojistik regresyon analizi ile araştırıldı. Bulgular: Genel hastane içi mortalite oranı %30.9 olarak bulundu. KDE'lerin %56.8'i Gram-negatif, %43.2'si ise Gram-pozitif patojenlerden kaynaklanmaktaydı. En sık izole edilen mikroorganizmalar Staphylococcus türleri (%33.8; diğer Staphylococcus türleri %26.6 ve Staphylococcus aureus %7.2), Klebsiella pneumoniae (%21.6) ve Acinetobacter baumannii (%12.9) idi. MDR ve CR ile hastane içi mortalite arasında anlamlı ilişki saptanmadı (p>0.05). Ancak Gram-negatif KDE bulunan hastalarda karbapenem dirençli izolatlar, karbapeneme duyarlı izolatlara kıyasla anlamlı derecede daha uzun hastane ve yoğun bakım yatış süreleri ile ilişkiliydi (her iki karşılaştırma için p=0.006). Tek değişkenli analizlerde Gram-negatif KDE, diyabetes mellitus, hipertansiyon ve cerrahi işlem tipi ile hastane içi mortalite arasında anlamlı ilişki bulundu. Çok değişkenli analizde ise uzamış kardiyopulmoner baypas (KPB) süresi (OR=1.015; %95 GA: 1.005–1.025; p=0.003) ve Gram-negatif KDE varlığı (OR=3.938; %95 GA: 1.225–12.659; p=0.021) hastane içi mortalitenin bağımsız belirleyicileri olarak saptandı. Sonuç: Antimikrobiyal direnç, hastane içi mortaliteyi artırmaktan ziyade sağlık hizmeti kaynak kullanımını etkileyerek daha uzun hastane ve yoğun bakım yatış süreleri ile ilişkili bulundu. Buna karşılık mortalite, bağımsız olarak Gram-negatif kan dolaşımı enfeksiyonları ve uzamış kardiyopulmoner baypas süresi ile ilişkiliydi.

Anahtar Kelimeler

• Kalp Damar Cerrahisi Işlemleri
• Bakteriyemi
• Ilaç Direnci
• Karbapenem Direnci
• Kardiyopulmoner Baypas

Kaynakça

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