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Infections and outcomes after cardiac surgery-The impact of outbreaks traced to transesophageal echocardiography probes.

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Authors
Vesteinsdottir, Edda
Helgason, Kristjan Orri
Sverrisson, Kristinn Orn
Gudlaugsson, Olafur
Karason, Sigurbergur
Issue Date
2019-08

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Infections and outcomes after cardiac surgery-The impact of outbreaks traced to transesophageal echocardiography probes. 2019, 63(7):871-878 Acta Anaesthesiol Scand
Abstract
BACKGROUND: Infections are a frequent complication of cardiac surgery. The intraoperative use of transesophageal echocardiography (TEE) may be an underrecognized risk factor for post-operative infections. The aim of this study was to investigate infection rates and outcomes after cardiac surgery in a nationwide cohort, especially in relation to periods where surface damaged TEE probes were used. METHODS: This was a retrospective, observational study at Landspitali University Hospital. All consecutive cardiac surgery patients from 1 January 2013 to 31 December 2017 were included. Patients' charts were reviewed for evidence of infection, post-operative complications or death. RESULTS: During the study period, 973 patients underwent cardiac surgery at Landspitali and 198 (20.3%) developed a post-operative infection. The most common infections were: Pneumonia (9.1%), superficial surgical site (5.7%), bloodstream (2.8%) and deep sternal wound (1.7%). Risk factors for developing an infection included: The duration of procedure, age, insulin-dependent diabetes, EuroScore II, reoperation for bleeding and an operation in a period with a surface damaged TEE probe in use. Twenty-two patients were infected with a multidrug resistant strain of Klebsiella oxytoca, 10 patients with Pseudomonas aeruginosa and two patients developed endocarditis with Enterococcus faecalis. All three pathogens were cultured from the TEE probe in use at respective time, after decontamination. The 30-day mortality rate in the patient cohort was 3.2%. CONCLUSIONS: The intraoperative use of surface damaged TEE probes caused two serious infection outbreaks in patients after cardiac surgery. TEE probes need careful visual inspection during decontamination and probe sheaths are recommended.
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https://onlinelibrary.wiley.com/doi/full/10.1111/aas.13360
ae974a485f413a2113503eed53cd6c53
10.1111/aas.13360
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