Bloodstream Infections After Invasive Nonsurgical Cardiologic Procedures

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, 0.06% corrected after diagnostic cardiac catheterization 9 cases of 14 034 patients, and 0.08% corrected 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.