Epidemiological surveillance of purulent-septic infections in cardiac surgery: limitations of traditional approaches and prospects for the application of whole-genome sequencing
Year: 2026
Type: article
Study design: Systematic Review
Abstract: Purulent-septic healthcare-associated infections (HAIs) in cardiac surgery are characterized by a high incidence rate (up to 30.8%), a diversity of clinical forms, and multiple risk factors. They worsen patients' condition and lead to increased mortality. The traditional system of epidemiological surveillance for purulent-septic HAIs and clinical-epidemiological models of risk stratification have systemic limitations: underestimation of incidence, a focus on exogenous sources, and an inability to promptly track the spread of multidrug-resistant hospital clones of opportunistic pathogens. Accumulated evidence indicates the dominant role of the patient's endogenous microbiota in the pathogenesis of postoperative infections, which requires a revision of approaches to surveillance and prevention in such patients. The authors conducted a search of published data in the databases PubMed, Google Scholar, eLibrary.ru, and NCBI for the period 1990–2025 using keywords covering the main nosological forms of purulent-septic infections in cardiac surgery and risk factors. Of the 2,453 initially identified publications, after applying inclusion criteria (patients from cardiac surgery hospitals, availability of data on the incidence of purulent-septic infections, and analysis of risk factors), 75 articles were selected for further analysis. The analysis revealed that traditional systems of epidemiological surveillance for HAIs in cardiac surgery are primarily focused on exogenous sources of contamination, while the main source of postoperative infections is the patient's endogenous microbiota (intestines, nasopharynx, skin). Therefore, it is necessary to include in prevention protocols measures for preoperative screening and decolonization of patients of carriage of opportunistic microorganisms (e.g., eradication of methicillin-resistant Staphylococcus aureus from the nasopharynx). The steady increase in antimicrobial resistance is turning cardiac surgery hospitals into reservoirs of multidrug-resistant hospital clones, which reduces the prognostic value of surveillance based on officially registered HAI cases and phenotypic characterization of pathogens. The use of whole-genome sequencing of opportunistic bacterial isolates allows solving several tasks at once: verifying pathogen transmission routes with single-nucleotide polymorphism resolution, differentiating clonal spread from endogenous infection, conducting a comprehensive analysis of resistance determinants, and tracking the horizontal transfer of resistance genes. Existing systems of epidemiological surveillance for purulent-septic HAIs in cardiac surgery require a critical revision of organizational approaches with the mandatory inclusion of molecular genetic methods. The application of whole-genome sequencing opens opportunities for transitioning from reactive outbreak investigation to proactive systemic monitoring of circulating strains.
DOI: 10.17816/eid705333
Institution: Ural State Medical University
Language: English
Topic: Nosocomial Infections in ICU
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7220868075