Background: This study aimed to investigate the incidence and risk factors of postoperative bloodstream infections (BSIs) in patients with Stanford type A aortic dissection (SAAD) and to develop a reliable predictive model to provide a more comprehensive understanding of the characteristics of this complication. Methods: Clinical data from 257 patients who underwent surgical repair for SAAD at the Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 2017 and July 2023 were retrospectively analyzed. Risk factors for postoperative BSIs were identified using univariate and multivariate logistic regression. A predictive model was constructed and validated based on the receiver operating characteristic (ROC) curve. Results: Based on a comprehensive analysis of 257 patients who underwent surgical repair for type A aortic dissection, this study identified an incidence of postoperative BSIs of 10.5%. Patients with BSIs experienced significantly worse outcomes, including prolonged intensive care unit (ICU) and overall hospital stays, and a higher incidence of complications such as liver failure, acute kidney injury, and cerebral infarction. In addition, postoperative BSI was associated with an increase in in-hospital mortality. Blood culture analysis revealed Gram-negative bacilli as the primary pathogens, with Acinetobacter baumannii and Enterobacter cloacae being the most prevalent, collectively accounting for 22.22% of all BSI cases. Multivariable analysis identified the following independent risk factors for postoperative BSI: preoperative C-reactive protein (odds ratios (OR) = 1.010, 95% confidence interval (CI) 1.002–1.019, p = 0.020), tracheostomy (OR = 9.186, 95% CI 2.463–34.266, p = 0.001), infectious pneumonia (OR = 32.872, 95% CI 4.186–258.174, p = 0.001), circulatory arrest time (OR = 1.048, 95% CI 1.004–1.093, p = 0.033), and age (OR = 1.055, 95% CI 1.010–1.103, p = 0.016). A predictive model constructed from these factors demonstrated strong discriminatory power, with an area under the ROC curve of 0.897. The model exhibited a sensitivity of 85.0% and a specificity of 90.0%, indicating good predictive accuracy within the study cohort. Conclusion: Postoperative bloodstream infection is a significant complication after surgical repair of Stanford type A aortic dissection, and is associated with worse clinical outcomes. A predictive model incorporating the independent risk factors of advanced age, elevated preoperative C-reactive protein, prolonged circulatory arrest time, tracheostomy, and infectious pneumonia aids in the early identification of high-risk patients. Future large-scale, multi-center studies are warranted to further validate and future refine these findings.
Xiao et al. (Tue,) studied this question.