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Bloodstream Infections After Invasive Nonsurgical Cardiologic Procedures
Patricia Muñoz, MD, PhD;
Jose Ramón Blanco, MD, PhD;
Marta Rodríguez-Creixéms, MD, PhD;
Eulogio García, MD, PhD;
Juan Luis Delcan, MD, PhD;
Emilio Bouza, MD, PhD
Arch Intern Med. 2001;161:2110-2115.
Objective To define the incidence, risk factors, and characteristics of bloodstream
infections (BSIs) after invasive nonsurgical cardiologic procedures (ICPs).
Methods Retrospective case-control study; multivariate analysis.
Results Between January 1991 and December 1998, 22 006 ICPs were performed
in our hospital and 25 BSIs were documented within 72 hours after ICP. Overall
incidence of bacteremia was 0.11% (25 cases) (0.24% after percutaneous transluminal
coronary angioplasty [14 cases of 5625 patients], 0.6% after diagnostic cardiac
catheterization [9 cases of 14 034 patients], and 0.8% after electrophysiologic
studies [2 cases of 2347 patients]). These 25 patients with bacteremia were
compared with 50 controls randomly selected among patients who underwent an
ICP but did not have BSIs. Patient-related risk factors for BSI were age older
than 60 years (20 cases [80%] vs 28 controls [56%]), valvular disease (4 [16%]
vs 1 [2%]), congestive heart failure (7 [28%] vs 1 [2%]), indwelling bladder
catheter before the ICP (5 [20%] vs 1 [2%]), more than 1 puncture for the
ICP (5 [20%] vs 3 [6%]), a prolonged procedure (83.7 vs 65.1 minutes); and/or
more than 1 ICP performed (2 [8%] vs 0). Multivariate analysis identified
the presence of congestive heart failure (odds ratio, 21; 95% confidence interval,
6.8-66.0) and age older than 60 years (odds ratio, 1.9; 95% confidence interval,
1.9-6.3) as independent risk factors for BSI after ICP. Bloodstream infection
was detected a median of 1.7 days after the procedure. Gram-negative bacteremia
accounted for 17 cases (68%) of the BSIs. Among the patients with BSI, the
duration of hospital stay was significantly increased (21 vs 6 days). The
overall mortality rate was 0.009% for patients who underwent an ICP (8.0%
for the 25 patients with bacteremia documented within 72 hours after ICP).
Conclusions Bloodstream infection should be included among the potential complications
of ICP. Elderly patients with recent congestive heart failure episodes constitute
a subgroup with a higher risk of postprocedure bacteremia. Therapy with antimicrobial
agents against gram-positive and gram-negative bacteremia should be initiated
after performing blood cultures in patients with signs suggestive of infection.
From the Clinical Microbiology Laboratory (Drs Muñoz, Blanco,
Rodríguez-Creixéms, and Bouza) and the Cardiology Department
(Drs García and Delcan), Hospital General Universitario "Gregorio Marañón,"
Madrid, Spain.
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