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Table 2 Comparison of preoperative, intraoperative and postoperative characteristics between cases of the first outbreak episode and control patients

From: A recurrent and transesophageal echocardiography–associated outbreak of extended-spectrum β-lactamase–producing Enterobacter cloacae complex in cardiac surgery patients

Categorical variables

Case patients, n (%)

Control patients, n (%)

Odds ratio (95% CI)

P value

 Female sex

4 (50)

2 (13)

7.00 (0.92–53.23)

.129

 Smokera

3 (38)

2 (13)

4.20 (0.54–32.96)

.289

 Medical history

  Congestive heart failure

4 (50)

5 (31)

2.20 (0.39–12.57)

.412

  Hypertension

7 (88)

7 (44)

9.00 (0.89–91.26)

.079

  Myocardial infarction

2 (25)

2 (13)

2.33 (0.26–20.66)

.578

  Peripheral vascular disease

1 (13)

2 (13)

1.00 (0.08–13.02)

1.000

  Cerebrovascular disease

1 (13)

3 (19)

0.62 (0.05–7.12)

1.000

  COPD

1 (13)

3 (19)

0.62 (0.05–7.12)

1.000

  Diabetes

0 (0)

4 (25)

0.29 (0.03–2.91)

.262

  Chronic renal failure

2 (25)

4 (25)

1.00 (0.14–7.10)

1.000

  Dialysis

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Cirrhosis

1 (13)

1 (6)

2.14 (0.12–39.47)

1.000

  Solid organ transplantation

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

  Previous cardiac surgery

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

 Preoperative ICUs or wardsb

  CSICU

2 (25)

1 (6)

5.00 (0.38–66.01)

.249

  CICU

1 (13)

5 (31)

0.31 (0.03–3.29)

.621

  MICU

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

  SICU

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Cardiac surgery ward

3 (38)

10 (63)

0.36 (0.06–2.08)

.390

  Cardiology ward

2 (25)

3 (19)

1.44 (0.19–11.04)

1.000

  Gastroenterology ward

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  General internal medicine ward

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

  Geriatric ward

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Nephrology ward

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

 Preoperative medicationc

  Antibioticsd

2 (25)

4 (25)

1.00 (0.14–7.10)

1.000

  Proton pump inhibitors

5 (63)

4 (25)

5.00 (0.81–31.00)

.099

  Systemic corticosteroids

1 (13)

1 (6)

2.14 (0.12–39.47)

1.000

 Preoperative ASA score of 5

4 (50)

0 (0)

17.00 (1.59–181.36)

.007

 Type of cardiac surgery

  Aortic dissection repair

2 (25)

0 (0)

7.29 (0.64–82.62)

.101

  Atrial surgerye

1 (13)

4 (25)

0.43 (0.04–4.64)

.631

  CABGf

2 (25)

6 (38)

0.56 (0.08–3.69)

.667

  Heart transplantation

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

  LVAD implantationf

2 (25)

0 (0)

7.29 (0.64–82.62)

.101

  Valve repair or replacementf

4 (50)

10 (63)

0.60 (0.11–3.34)

.673

 Emergency operation

4 (50)

0 (0)

17.00 (1.59–181.36)

.007

 Operating room

  Operating room A

6 (75)

9 (56)

2.33 (0.36–15.30)

.657

  Operating room B

1 (13)

7 (44)

0.18 (0.02–1.86)

.189

  Operating room C

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

 Surgeons

  Surgeon A

4 (50)

8 (50)

1.00 (0.18–5.46)

1.000

  Surgeon B

4 (50)

6 (38)

1.67 (0.30–9.27)

.673

  Surgeon C

4 (50)

5 (31)

2.20 (0.39–12.57)

.412

  Surgeon D

2 (25)

8 (50)

0.33 (0.05–2.18)

.388

  Surgeon E

2 (25)

6 (38)

0.56 (0.08–3.69)

.667

  Surgeon F

2 (25)

0 (0)

7.29 (0.64–82.62)

.101

  Surgeon G

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Surgeon H

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Surgeon I

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Surgeon J

0 (0)

4 (25)

0.29 (0.03–2.91)

.262

  Surgeon K

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

 Anesthesiologists

  Anesthesiologist A

5 (63)

7 (44)

2.14 (0.38–12.20)

.667

  Anesthesiologist B

3 (38)

6 (38)

1.00 (0.17–5.77)

1.000

  Anesthesiologist C

2 (25)

6 (38)

0.56 (0.08–3.69)

.667

  Anesthesiologist D

2 (25)

3 (19)

1.44 (0.19–11.04)

1.000

  Anesthesiologist E

2 (25)

1 (6)

5.00 (0.38–66.01)

.249

  Anesthesiologist F

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Anesthesiologist G

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  Anesthesiologist H

0 (0)

3 (19)

0.39 (0.04–4.06)

.526

  Anesthesiologist I

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

  Anesthesiologist J

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

  Anesthesiologist K

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

  Anesthesiologist L

0 (0)

1 (6)

0.89 (0.07–11.22)

1.000

 Surgical antibiotic prophylaxis

  Cefazoline

5 (63)

14 (88)

0.24 (0.03–1.87)

.289

  Vancomycin

1 (13)g

0 (0)

4.25 (0.33–54.07)

.333

  Amoxicillin–clavulanic acid

1 (13)

0 (0)

4.25 (0.33–54.07)

.333

  No additional coverageh

1 (13)

2 (13)

1.00 (0.08–13.02)

1.000

 Sternotomy

7 (88)

12 (75)

2.33 (0.22–25.25)

.631

 ECC

8 (100)

16 (100)

-i

-i

 Intraoperative TEE

8 (100)

16 (100)

-i

-i

 Postoperative TEEj

7 (88)

5 (31)

15.40 (1.47–160.97)

.027

 Need for revisionk

5 (63)l

0 (0)

25.50 (2.36–275.74)

.001

 Beds occupied at CSICUm

  Bed A

1 (13)

4 (25)

0.43 (0.04–4.64)

.631

  Bed B

1 (13)

3 (19)

0.62 (0.05–7.12)

1.000

  Bed C

0 (0)

3 (19)

0.39 (0.04–4.06)

.526

  Bed D

1 (13)

3 (19)

0.62 (0.05–7.12)

1.000

  Bed E

4 (50)

1 (6)

15.00 (1.29–174.39)

.028

  Bed F

2 (25)

0 (0)

7.29 (0.64–82.62)

.101

  Bed G

2 (25)

1 (6)

5.00 (0.38–66.01)

.249

  Bed H

1 (13)

1 (6)

2.14 (0.12–39.47)

1.000

  Bed I

1 (13)

2 (13)

1.00 (0.08–13.02)

1.000

  Bed J

0 (0)

4 (25)

0.29 (0.03–2.91)

.262

 Deathn

2 (25)

1 (6)

5.00 (0.38–66.01)

.249

Continuous variables

Case patients, median (IQR)

Control patients, median (IQR)

P value

 Age (yrs)

74 (54–80)

67 (55–77)

.610

 BMI (kg/m2)

26.5 (24.7–31.0)

26.2 (24.0–28.2)

.492

 Preoperative length of stay (days)

2 (0–5)

2 (1–8)

.490

 Duration of surgery (minutes)

275 (221–394)

197 (158–223)

.011

 Duration of ECC (minutes)

116 (99–356)

106 (79–145)

.198

 Length of stay at CSICU (days)

15 (6–31)

3 (1–5)

.006

 Postoperative length of stay (days)

30 (26–39)

10 (7–13)

<.001

 Total length of stay (days)

34 (26–63)

12 (8–25)

.001

  1. Abbreviations: ASA American Society of Anesthesiologists, BMI body mass index, CABG coronary artery bypass grafting, CI confidence interval, CICU cardiac intensive care unit, COPD chronic obstructive pulmonary disease, CSICU cardiac surgery intensive care unit, ECC extracorporeal circulation, ESBL extended-spectrum β-lactamase, ICU intensive care unit, IQR interquartile range, LVAD left ventricular assist device, MICU medical intensive care unit, SD standard deviation, SICU surgical intensive care unit, TEE transesophageal echocardiography
  2. aCurrent smoker. Findings were similar when smoking history was analyzed (data not shown)
  3. bIntensive care units or wards where the patient was hospitalized prior to cardiac surgery
  4. cRecent medication use (within seven days of cardiac surgery)
  5. dPreoperative use of antibiotics for therapeutic purposes (infection). See below for perioperative antibiotic prophylaxis
  6. eOne or more of the following procedures: left atrial appendage exclusion, maze procedure, patent foramen ovale closure. Atrial surgery was always performed in conjunction with another cardiac surgical procedure
  7. fAlone or in combination with another cardiac surgical procedure
  8. gVancomycin was administered prophylactically to one patient who was already on treatment with piperacillin–tazobactam
  9. hNo additional prophylactic use of antibiotics in patients already on antibiotic treatment
  10. iMeasures of association were not computed for categorical variables that had a constant value in each of the cases and controls
  11. jTraceable TEE examination in the postoperative period. This may be an underestimation of the actual number of patients who had postoperative TEE examinations due to underregistration
  12. kPostoperative need for urgent reoperation because of a major non-infectious complication
  13. lFour patients required one or more revision operations for bleeding with imminent or manifest pericardial tamponade. Five of these revision operations occurred prior to infection with ESBL-producing E. cloacae complex (see Table 1). A fifth patient was reoperated because of postoperative mitral regurgitation with hemodynamic instability. This revision took place shortly after the onset of infection with ESBL-producing E. cloacae complex
  14. mBeds where the patient stayed at CSICU
  15. nFatal outcome (overall mortality)
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Antimicrobial Resistance & Infection Control

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