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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)