Original article: cardiovascular
Association of bacterial infection and red blood cell transfusion after coronary artery bypass surgery

https://doi.org/10.1016/S0003-4975(01)03308-2Get rights and content

Abstract

Background. Previous studies have shown an association between red blood cell transfusions (RBC) and bacterial infections following coronary artery bypass graft (CABG) surgery. We sought to assess whether there is an independent effect of RBC on the incidence of bacterial infections.

Methods. This was a prospective cohort study of 533 CABG patients over a 7-month period. Subjects were followed from time of CABG until 30 days postoperatively. Data were collected on patient and treatment characteristics, surgical management, and transfusion incidence.

Results. Seventy-five (14.1%) of 533 patients developed a bacterial infection. After controlling for patient and disease characteristics, invasive treatments, surgical time, and the transfusion of other substances, the adjusted rates of bacterial infection were 4.8% for no RBC transfusion, 15.2% with one to two units, 22.1% with three to five units, and 29.0% with greater than or equal to six units, (ptrend < 0.001). Diabetes was the only patient or disease factor significantly associated with bacterial infection (p < 0.001).

Conclusions. RBC transfusions were independently associated with a higher incidence of post-CABG bacterial infections. The risk of infection increased in proportion to the number of units of RBC transfused.

Section snippets

Patient selection

During a 7-month period, 605 adult patients underwent primary isolated CABG at Maine Medical Center, a tertiary care, university-affiliated teaching hospital. We excluded patients who received antimicrobial therapy during the 72 hours prior to surgery (n = 60), transfusion of any blood products during the week preceding surgery (n = 8), and those who expired within 48 hours of CABG (n = 4). The remaining 533 patients were enrolled in the study and followed postoperatively with daily reviews of

Results

Seventy-five of 533 patients developed a bacterial infection during the study (14.1%). Of these, 46 (61.3%) developed bacterial infection prior to hospital discharge and 29 (38.7%) developed infection after discharge. Nine patients died; 5 of 75 (6.7%) with bacterial infection died, while 4 of 458 (0.9%) of non-infected patients died (p < 0.001). The endpoint of the study for the remaining 485 patients was their 1-month post-discharge office visit. The questionnaire response rate for these

Comment

In this prospective study, 533 patients having isolated CABG surgery were studied and 75 (14.1%) developed a bacterial infection. The sites of the infections were 32.4% respiratory, 41.9% superficial SSI, 8.1% deep SSI (all sternal), and 17.6% at other sites. After adjustment for patient and treatment characteristics, surgical times, and the transfusion of other substances, the rates of postoperative bacterial infection remained strongly associated with the number of units of RBC transfused.

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