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Peer-reviewedCC BY-NC 4.0Infection and Drug Resistance

Bloodstream Infections After Cardiac Surgery: Pathogen Distribution, Antimicrobial Resistance, and a Nomogram Prediction Model

  • Shuxian Miao1,2
  • Yanfei Lu1,2
  • Jue Wang1,2
  • Wei Zhang1,2
  • Wenying Xia1,2
  • Yuqiao Xu1,2
  1. 1Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People’s Republic of China
  2. 2Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People’s Republic of China
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Abstract

Background: Postoperative bloodstream infection (BSI) is a severe complication following cardiac surgery, associated with significant mortality. This study aims to characterize pathogen profiles, antimicrobial resistance and independent risk factors for BSI in a Chinese cardiac surgery cohort.

Methods: We conducted a retrospective cohort study of postoperative BSI in patients who underwent cardiac surgery at the First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2024. Patients who developed postoperative BSI were identified and a 1:1 propensity score matched analysis were performed to adjust for baseline characteristics of patients. Univariate and multivariate analysis were applied to identify independent risk factors for postoperative BSI. R software was used to construct a prediction nomogram, followed by internal validation.

Results: During the study, a total of 10,007 patients underwent heart surgery, and 164 pairs of patients were successfully matched using propensity score matching. Gram-negative bacteria were the most common pathogens (64.1%), followed by Fungi (18.2%) and Gram-positive bacteria (17.6%). Among Enterobacterales, 33.8% were carbapenem-resistant, with carbapenem-resistant Klebsiella pneumoniae (CRKP) accounting for 63.6% of K. pneumoniae isolates. Meanwhile, 85.0% (17/20) of A. baumannii isolates were multidrug-resistant A. baumannii (MDRAB). The 90-day mortality rate in the BSI group was 39.0%, significantly higher than that in the non-BSI group (4.9%, P < 0.001). Multivariate logistic regression identified impaired cardiac function (New York Heart Association II–IV, NYHA II–IV) (OR=5.583, 95% CI:2.681–11.627), pulmonary infection (OR =4.053, 95% CI:1.692–9.710), emergency surgery (OR=9.629, 95% CI:2.962–31.301), coronary artery bypass grafting (CABG) (OR=2.796, 95% CI:1.096–7.134), continuous renal replacement therapy (CRRT Postoperative ICU stay ≥ 14 d) (OR=4.758, 95% CI:1.854–12.211) and postoperative ICU stay ≥14 d (OR=14.616, 95% CI:6.765–31.577) as independent risk factors for postoperative BSI. The nomogram showed good discrimination and calibration after internal validation, with an optimism-corrected C-index of 0.913 and a mean absolute calibration error of 0.026.

Conclusion: Postoperative BSI in cardiac surgery patients is associated with high mortality. A nomogram based on impaired cardiac function (NYHA II–IV), pulmonary infection, emergency surgery, CABG, CRRT and postoperative ICU stay ≥14 d displayed high accuracy and consistency in predicting the risk of postoperative BSI. These results facilitate early risk stratification and guide preventive strategies in high-risk cardiac surgical patients.

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Cite

BibTeXRIS
BibTeX
@article{miao2026bloodstream,
  title = {{Bloodstream Infections After Cardiac Surgery: Pathogen Distribution, Antimicrobial Resistance, and a Nomogram Prediction Model}},
  author = {Shuxian Miao and Yanfei Lu and Jue Wang and Wei Zhang and Wenying Xia and Yuqiao Xu},
  journal = {Infection and Drug Resistance},
  year = {2026},
  month = nov,
  doi = {10.2147/idr.s640210},
  url = {https://doi.org/10.2147/idr.s640210},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Bloodstream Infections After Cardiac Surgery: Pathogen Distribution, Antimicrobial Resistance, and a Nomogram Prediction Model
AU  - Shuxian Miao
AU  - Yanfei Lu
AU  - Jue Wang
AU  - Wei Zhang
AU  - Wenying Xia
AU  - Yuqiao Xu
PY  - 2026
DA  - 2026/11/01
JO  - Infection and Drug Resistance
DO  - 10.2147/idr.s640210
UR  - https://doi.org/10.2147/idr.s640210
AB  - Background: Postoperative bloodstream infection (BSI) is a severe complication following cardiac surgery, associated with significant mortality. This study aims to characterize pathogen profiles, antimicrobial resistance and independent risk factors for BSI in a Chinese cardiac surgery cohort.  Methods: We conducted a retrospective cohort study of postoperative BSI in patients who underwent cardiac surgery at the First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2024. Patients who developed postoperative BSI were identified and a 1:1 propensity score matched analysis were performed to adjust for baseline characteristics of patients. Univariate and multivariate analysis were applied to identify independent risk factors for postoperative BSI. R software was used to construct a prediction nomogram, followed by internal validation.  Results: During the study, a total of 10,007 patients underwent heart surgery, and 164 pairs of patients were successfully matched using propensity score matching. Gram-negative bacteria were the most common pathogens (64.1%), followed by Fungi (18.2%) and Gram-positive bacteria (17.6%). Among Enterobacterales, 33.8% were carbapenem-resistant, with carbapenem-resistant Klebsiella pneumoniae (CRKP) accounting for 63.6% of K. pneumoniae isolates. Meanwhile, 85.0% (17/20) of A. baumannii isolates were multidrug-resistant A. baumannii (MDRAB). The 90-day mortality rate in the BSI group was 39.0%, significantly higher than that in the non-BSI group (4.9%, P < 0.001). Multivariate logistic regression identified impaired cardiac function (New York Heart Association II–IV, NYHA II–IV) (OR=5.583, 95% CI:2.681–11.627), pulmonary infection (OR =4.053, 95% CI:1.692–9.710), emergency surgery (OR=9.629, 95% CI:2.962–31.301), coronary artery bypass grafting (CABG) (OR=2.796, 95% CI:1.096–7.134), continuous renal replacement therapy (CRRT Postoperative ICU stay ≥ 14 d) (OR=4.758, 95% CI:1.854–12.211) and postoperative ICU stay ≥14 d (OR=14.616, 95% CI:6.765–31.577) as independent risk factors for postoperative BSI. The nomogram showed good discrimination and calibration after internal validation, with an optimism-corrected C-index of 0.913 and a mean absolute calibration error of 0.026.  Conclusion: Postoperative BSI in cardiac surgery patients is associated with high mortality. A nomogram based on impaired cardiac function (NYHA II–IV), pulmonary infection, emergency surgery, CABG, CRRT and postoperative ICU stay ≥14 d displayed high accuracy and consistency in predicting the risk of postoperative BSI. These results facilitate early risk stratification and guide preventive strategies in high-risk cardiac surgical patients.
SN  - 1178-6973
ER  -