Role of risk factors in the development of nosocomial infections after cardiac surgery: a review

Prevention of nosocomial infections in cardiac surgery patients during the postoperative period is a critical task, both from an economic perspective and for improving the quality and longevity of life in patients with cardiovascular diseases. The relevance of assessing the risk of infectious complications in this population is confirmed by numerous publications in both Russian and international journals. An analysis of original studies and reviews in Embase, PubMed, ResearchGate, eLibrary, and Google Scholar indicated that effective prediction of nosocomial infections in cardiac surgery patients requires consideration of a combination of parameters that exert a synergistic influence on infection risk. Key preoperative risk factors include age over 60 years, body mass index >24 kg/m², smoking, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, severe chronic heart failure, peripheral vascular disease, and previous cardiac surgery. Upon hospital admission, the likelihood of developing nosocomial infections may be influenced by pronounced preoperative hypoalbuminemia, anemia, low hematocrit, and elevated serum creatinine. Intraoperative risk factors include cardiopulmonary bypass duration exceeding 120 minutes, intraoperative blood loss > 2000 mL, and infusion of large volumes of replacement fluids. In the future, artificial intelligence could be utilized to develop a risk assessment scoring system.

The role of the pathobiome and chronic infectious foci in the development of nosocomial complications in cardiac surgery patients remains insufficiently studied and requires further research. Endogenous sources of infection may play a more significant role in the development of nosocomial infections than exogenous contamination.