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INTENSIVE CARE MEDICINE / CLINICAL RESEARCH
Survival analysis of antibiotics in patients undergoing cardiopulmonary bypass in the intensive care unit: a study based on the Medical Information Mart for Intensive Care-IV database
1
Department of Blood Transfusion, the First Affiliated Hospital of Hebei North University, Hebei, China
2
Department of Anesthesiology, the First Affiliated Hospital of Hebei North University, Hebei, China
Submission date: 2024-07-18
Final revision date: 2024-10-28
Acceptance date: 2024-10-29
Online publication date: 2024-11-02
Corresponding author
Congna Zi
Department of Anesthesiology the First Affiliated Hospital of Hebei North University 12 Changqing Road Zhangjiakou, Hebei 075000, China Phone: +86 13303137337
Department of Anesthesiology the First Affiliated Hospital of Hebei North University 12 Changqing Road Zhangjiakou, Hebei 075000, China Phone: +86 13303137337
Arch Med Sci 2025;21(5):1874-1886
KEYWORDS
TOPICS
ABSTRACT
Introduction:
This study aimed to evaluate the influence of antibiotics on the survival of patients in the intensive care unit (ICU) undergoing cardiopulmonary bypass (CPB) treatment.
Material and methods:
This retrospective cohort study included data of 7,296 patients who underwent CPB surgery and were admitted to the ICU from the MIMIC-IV database. Patients with CPB were grouped according to their survival time of more than 30 days or less after admission and whether antibiotics were used, with baseline characteristics analyzed. Survival differences were assessed using Kaplan-Meier (K-M) curves. Landmark analysis was used to assess inter-group survival differences before and after specific time points. Three models were constructed by adjusting for different covariates. Cox regression analysis assisted with the association analysis between antibiotic use and the mortality risk in CPB patients. According to subgroup analysis, survival differences between distinct subgroups of CPB patients were compared.
Results:
In CPB patients grouped according to survival time, large differences were detected in laboratory indexes, comorbidities, and treatment information. In terms of disease severity scores, vital signs, and comorbidity, there were notable differences in the data in CPB patients grouped by whether antibiotics were administered. K-M curves showed that the use of antibiotics substantially increased the 30-day survival rate of all CPB patients as well as CPB patients without sepsis complications. Landmark analysis indicated that the use of antibiotics greatly increased the survival rates of all CPB patients and CPB patients without sepsis complications at 7 and 14 days after ICU admission. Cox regression analysis demonstrated that the mortality risk of patients using antibiotics was significantly reduced in all CPB patients and CPB patients without sepsis complications. The mortality risk was considerably lower in CPB patients with SOFA scores in the range of (–1, 5] (HT = 0.28, 95% CI: 0.21–0.37, p < 0.001), ICU stay ≤ 3 days ((0, 2]: HT = 0.22, 95% CI: 0.15–0.32, p < 0.001; (2, 3]: HT = 0.33, 95% CI: 0.21–0.53, p < 0.001), and those who did not receive renal replacement therapy (RRT) (HT = 0.37, 95% CI: 0.29–0.47, p < 0.001).
Conclusions:
In CPB patients admitted to the ICU, the rational use of antibiotics for treatment and prophylaxis can significantly reduce the risk of mortality. These findings provide insights for clinical practice, assisting healthcare professionals to better assess and manage CPB patients in the ICU and formulate appropriate treatment plans to improve patient survival rates.
This study aimed to evaluate the influence of antibiotics on the survival of patients in the intensive care unit (ICU) undergoing cardiopulmonary bypass (CPB) treatment.
Material and methods:
This retrospective cohort study included data of 7,296 patients who underwent CPB surgery and were admitted to the ICU from the MIMIC-IV database. Patients with CPB were grouped according to their survival time of more than 30 days or less after admission and whether antibiotics were used, with baseline characteristics analyzed. Survival differences were assessed using Kaplan-Meier (K-M) curves. Landmark analysis was used to assess inter-group survival differences before and after specific time points. Three models were constructed by adjusting for different covariates. Cox regression analysis assisted with the association analysis between antibiotic use and the mortality risk in CPB patients. According to subgroup analysis, survival differences between distinct subgroups of CPB patients were compared.
Results:
In CPB patients grouped according to survival time, large differences were detected in laboratory indexes, comorbidities, and treatment information. In terms of disease severity scores, vital signs, and comorbidity, there were notable differences in the data in CPB patients grouped by whether antibiotics were administered. K-M curves showed that the use of antibiotics substantially increased the 30-day survival rate of all CPB patients as well as CPB patients without sepsis complications. Landmark analysis indicated that the use of antibiotics greatly increased the survival rates of all CPB patients and CPB patients without sepsis complications at 7 and 14 days after ICU admission. Cox regression analysis demonstrated that the mortality risk of patients using antibiotics was significantly reduced in all CPB patients and CPB patients without sepsis complications. The mortality risk was considerably lower in CPB patients with SOFA scores in the range of (–1, 5] (HT = 0.28, 95% CI: 0.21–0.37, p < 0.001), ICU stay ≤ 3 days ((0, 2]: HT = 0.22, 95% CI: 0.15–0.32, p < 0.001; (2, 3]: HT = 0.33, 95% CI: 0.21–0.53, p < 0.001), and those who did not receive renal replacement therapy (RRT) (HT = 0.37, 95% CI: 0.29–0.47, p < 0.001).
Conclusions:
In CPB patients admitted to the ICU, the rational use of antibiotics for treatment and prophylaxis can significantly reduce the risk of mortality. These findings provide insights for clinical practice, assisting healthcare professionals to better assess and manage CPB patients in the ICU and formulate appropriate treatment plans to improve patient survival rates.
REFERENCES (45)
1.
Takahashi H, Kinoshita T, Soh Z, et al. Simultaneous control of venous reservoir level and arterial flow rate in cardiopulmonary bypass with a centrifugal pump. IEEE J Transl Eng Health Med 2023; 11: 435-40.
2.
Abouzid M, Roshdy Y, Daniel JM, et al. The beneficial use of nitric oxide during cardiopulmonary bypass on postoperative outcomes in children and adult patients: a systematic review and meta-analysis of 2897 patients. Eur J Clin Pharmacol.2023; 79: 1425-42.
3.
Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002; 97: 215-52.
4.
Rhodes LA, Robert SM, Atkinson TP, Dabal RJ, Mahdi AM, Alten JA. Hypogammaglobulinemia after cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg 2014; 147: 1587-93 e1.
5.
Wang YC, Wu HY, Luo CY, Lin TW. Cardiopulmonary bypass time predicts early postoperative enterobacteriaceae bloodstream infection. Ann Thorac Surg 2019; 107: 1333-41.
6.
Almashrafi A, Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Serv Res 2016; 16: 318.
7.
Lannemyr L, Bragadottir G, Krumbholz V, Redfors B, Sellgren J, Ricksten SE. Effects of cardiopulmonary bypass on renal perfusion, filtration, and oxygenation in patients undergoing cardiac surgery. Anesthesiology 2017; 126: 205-13.
8.
Besser MW, Klein AA. The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci 2010; 47: 197-212.
9.
Zhang X, Zhang W, Lou H, et al. Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass: a retrospective observational study. Int J Nurs Sci 2021; 8: 388-93.
10.
Wang Q, Liu H, Zou L, et al. Early predictors of bacterial pneumonia infection in children with congenital heart disease after cardiopulmonary bypass: a single-centre retrospective study. BMJ Open 2024; 14: e076483.
11.
Rimmler C, Lanckohr C, Mittrup M, et al. Population pharmacokinetic evaluation of cefuroxime in perioperative antibiotic prophylaxis during and after cardiopulmonary bypass. Br J Clin Pharmacol 2021; 87: 1486-98.
12.
Lagrost L, Girard C, Grosjean S, et al. Low preoperative cholesterol level is a risk factor of sepsis and poor clinical outcome in patients undergoing cardiac surgery with cardiopulmonary bypass. Crit Care Med 2014; 42: 1065-73.
13.
Yao RQ, Jin X, Wang GW, et al. A machine learning-based prediction of hospital mortality in patients with postoperative sepsis. Front Med 2020; 7: 445.
14.
Robich MP, Sabik JF 3rd, Houghtaling PL, et al. Prolonged effect of postoperative infectious complications on survival after cardiac surgery. Ann Thorac Surg 2015; 99: 1591-9.
15.
Miao Q, Chen SN, Zhang HJ, et al. A pilot assessment on the role of procalcitonin dynamic monitoring in the early diagnosis of infection post cardiac surgery. Front Cardiovasc Med 2022; 9: 834714.
16.
Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med 2014; 42: 1749-55.
17.
Puskarich MA, Trzeciak S, Shapiro NI, et al. Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Crit Care Med 2011; 39: 2066-71.
18.
Zukowska A, Zukowski M. Surgical site infection in cardiac surgery. J Clin Med 2022; 11: 6991.
19.
Paruk F, Sime FB, Lipman J, Roberts JA. Dosing antibiotic prophylaxis during cardiopulmonary bypass-a higher level of complexity? A structured review. Int J Antimicrob Agents 2017; 49: 395-402.
20.
Luz HL, Auler Junior JO. Temperature and acid-base balance in coronary bypass grafting with cardiopulmonary bypass, under hypothermia and normothermia. Rev Bras Anestesiol 2002; 52: 197-208.
21.
Mork C, Gahl B, Eckstein F, Berdajs DA. Prolonged cardiopulmonary bypass time as predictive factor for bloodstream infection. Heliyon 2023; 9: e17310.
22.
Fan T, Wang H, Wang J, Wang W, Guan H, Zhang C. Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database. BMC Endocr Disord 2021; 21: 37.
23.
Dorken Gallastegi A, Gebran A, Gaitanidis A, et al. Early versus late enteral nutrition in critically ill patients receiving vasopressor support. JPEN J Parenter Enteral Nutr 2022; 46: 130-40.
24.
Blazek K, van Zwieten A, Saglimbene V, Teixeira-Pinto A. A practical guide to multiple imputation of missing data in nephrology. Kidney Int 2021; 99: 68-74.
25.
Liu JY, Liu LP, Li Z, Luo YW, Liang F. The role of cuproptosis-related gene in the classification and prognosis of melanoma. Front Immunol 2022; 13: 986214.
26.
Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 2006; 296: 2460-6.
27.
Hubner M, Tomasi R, Effinger D, et al. Myeloid-derived suppressor cells mediate immunosuppression after cardiopulmonary bypass. Crit Care Med 2019; 47: e700-9.
28.
Alli A, Paruk F, Roger C, et al. Peri-operative pharmacokinetics of cefazolin prophylaxis during valve replacement surgery. PLoS One 2023; 18: e0291425.
29.
Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003; 9: 196-203.
30.
Kutob LF, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections. Int J Antimicrob Agents 2016; 48: 498-503.
31.
Wirz Y, Meier MA, Bouadma L, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care 2018; 22: 191.
32.
Falcone M, Russo A, Iacovelli A, et al. Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Clin Microbiol Infect 2016; 22: 444-50.
33.
Rahmanian PB, Adams DH, Castillo JG, Carpentier A, Filsoufi F. Predicting hospital mortality and analysis of long-term survival after major noncardiac complications in cardiac surgery patients. Ann Thorac Surg 2010; 90: 1221-9.
34.
Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 2014; 312: 90-2.
35.
Liu VX, Fielding-Singh V, Greene JD, et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med 2017; 196: 856-63.
36.
Ferrer R, Martinez ML, Goma G, et al. Improved empirical antibiotic treatment of sepsis after an educational intervention: the ABISS-Edusepsis study. Crit Care 2018; 22: 167.
37.
Hamouda K, Oezkur M, Sinha B, et al. Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: an observational study. J Cardiothorac Surg 2015; 10: 25.
38.
Hein OV, Birnbaum J, Wernecke K, England M, Konertz W, Spies C. Prolonged intensive care unit stay in cardiac surgery: risk factors and long-term-survival. Ann Thorac Surg 2006; 81: 880-5.
39.
Ceriani R, Mazzoni M, Bortone F, et al. Application of the sequential organ failure assessment score to cardiac surgical patients. Chest 2003; 123: 1229-39.
40.
Howitt SH, Caiado C, McCollum C, et al. Validation of three postoperative risk prediction models for intensive care unit mortality after cardiac surgery. Thorac Cardiovasc Surg 2018; 66: 651-60.
41.
Moreno R, Vincent JL, Matos R, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 1999; 25: 686-96.
42.
Xu F, Li W, Zhang C, Cao R. Performance of sequential organ failure assessment and Simplified Acute Physiology Score II for post-cardiac surgery patients in intensive care unit. Front Cardiovasc Med 2021; 8: 774935.
43.
Doerr F, Badreldin AM, Heldwein MB, et al. A comparative study of four intensive care outcome prediction models in cardiac surgery patients. J Cardiothorac Surg 2011; 6: 21.
44.
Thongprayoon C, Cheungpasitporn W, Shah IK, et al. Long-term outcomes and prognostic factors for patients requiring renal replacement therapy after cardiac surgery. Mayo Clin Proc 2015; 90: 857-64.
45.
Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005; 294: 813-8.
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