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* From the Critical Care Division (Drs. Leal-Noval, Rincón-Ferrari, Herruzo-Avilés, Camacho-Laraña, Garnacho-Montero, and Amaya-Villar) and the Microbiology Division (Dr. García-Curiel), Hospital Universitario "Virgen del Rocío," Seville, Spain.
Correspondence to: Santiago Ramón Leal-Noval, MD, Servicio de Cuidados Críticos y Urgencias. Hospital Universitario "Virgen del Rocío," Avda Manuel Siurot s/n, 41013. Seville, Spain; e-mail: sramon{at}cica.es
Objective: To investigate the influence of blood derivatives on the acquisition of severe postoperative infection (SPI) in patients undergoing heart surgery.
Setting: The postoperative ICUs of a tertiary-level university hospital.
Design: A cohort study.
Methods: During a 4-year period, 738 patients, classified as patients with SPIs and patients without SPIs (non-SPI patients), were included in the study. We studied the influence of 36 variables on the development of SPI in general and individually for pneumonia, mediastinitis, and/or septicemia. The influence of the blood derivatives on infections was assessed for RBC concentrates, RBC and plasma, and RBC and platelets.
Results: Seventy patients (9.4%) were
classified as having SPIs, and 668 (90.6%) were classified as not
having SPIs. After multivariate analysis, the variables
associated with SPI (incidence, 9.4%) were reintubation, sternal
dehiscence, mechanical ventilation (MV) for 
48 h, reintervention,
neurologic dysfunction, transfusion of 4 U RBCs, and systemic
arterial hypotension. The variables associated with nosocomial
pneumonia (incidence, 5.9%) were reintubation, MV for 48 h,
neurologic dysfunction, transfusion of 4 U blood components, and
arterial hypotension. The variables associated with mediastinitis
(incidence, 2.3%) were reintervention and sternal dehiscence, and
those associated with sepsis (incidence, 1.6%) were reintubation, time
of bypass 110 min, and MV for 48 h. The mortality rate
(patients with SPI, 52.8%; non-SPI patients, 8.2%; p < 0.001) and
mean (± SD) length of stay in the ICU (patients with SPI,
15.8 ± 12.9 days; non-SPI patients, 4.5 ± 4.4 days; p < 0.001)
were greater for the infected patients. The transfused patients also
had a greater mortality rate (13.3% vs 8.9%, respectively;
p < 0.001) and a longer mean stay in the ICU (6.1 ± 7.2 days vs
3.7 ± 2.8 days, respectively; p < 0.01) than those not
transfused.
Conclusion: The administration of blood derivatives, mainly RBCs, was associated in a dose-dependent manner with the development of SPIs, primarily nosocomial pneumonia.
Key Words: cardiac surgery • nosocomial pneumonia • postoperative infection • transfusion
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