Cardiosurgery is a high-risk procedure, putting patient at risk for hospital-acquired complications such as infection. With an estimated attributable mortality fraction of 17.1 %, some hospital-acquired infections after cardiosurgery may substantially compromise the odds of survival (Toumpoulis et al., 2005). Surgical site infection (SSI) following open-heart surgery is a complication with substantial impact on patient morbidity (Massart et al., 2022). In 2019, the European Centre for Disease Prevention and Control (ECDC) reported a SSI rate following coronary artery bypass graft CABG of 2.6 % [0.0–5.5] in Europe, and 2.4 % [1.5–3.5] in Italy (European Centre for Disease Prevention and Control, 2018). SSI incidence generally ranges 0.9 % to 20 % (Ridderstolpe et al., 2001). This variation, as with other healthcare-associated infections, may be explained by differences in case-mix, classification methods, and compliance to preventive measures (Blot et al., 2022, Vos et al., 2018, Zukowska and Zukowski, 2022).

As there is no contamination by viscera, cardiosurgery is considered “clean” thereby assuming a low risk of SSIs (Kühme et al., 2007). Nonetheless, endogenous and exogenous pathogens may contribute to wound contamination and subsequent infection. Multiple factors may contribute to SSI in cardiosurgery and are either patient or procedure related (Sharif et al., 2019). Commonly reported risk factors include diabetes mellitus, obesity, and artery bypass grafting (Lemaignen et al., 2015). Analysis of risk factors may help identifying patients at risk thereby leading to a more targeted prevention program (Ridderstolpe et al., 2001). Furthermore, surveillance data are pivotal as they provide information required to underpin specific objectives. The data should also be used for routine feedback to the clinical team and to steer infection prevention initiatives (Sharif et al., 2019). Consequently, the ECDC report describes surveillance data as “motivators for clinical change within an hospital setting and used as quality indicators” (European Centre for Disease Prevention and Control, 2018) (National Heathcare Safety Network, 2023).

The objective of this study is to identify risk factors for SSI in cardiosurgical patients within our specific hospital population. Data was derived from a continuous quality improvement program of the infection control team. As the South of Italy is endemic for MDRO, special emphasis was given to MDRO carriership as a potential risk factor (Istituto Superiore di Sanità, 2022).