The Burden of Postoperative Nosocomial Infections: Mortality, ICU Admissions, and Prolonged Hospitalization

Abstract Background: Postoperative nosocomial infections are a major cause of morbidity and mortality in surgical patients, increasing ICU admissions, prolonging hospitalization, and driving healthcare costs. The emergence of multidrug-resistant organisms further complicates management. Materials and Methods: We conducted a retrospective observational single-center study at Municipal Hospital Mangalia (January 2019–December 2024). Data collected comprised demographics, comorbidities, surgical site, laboratory values, bacterial cultures, and antibiotic resistance patterns. Outcomes analyzed included ICU admission, in-hospital mortality, and prolonged hospitalization. Results: 56 patients met the inclusion criteria. Gram-negative bacteria predominated, with Pseudomonas aeruginosa (25.0%) most common. Antibiotic resistance was present in 60.7% of isolates, most frequently to tetracycline (19.6%) and erythromycin (16.1%). ICU admission occurred in 14 patients (25.0%), and in-hospital mortality was 10.7%. Median hospital stay was 23.5 days (IQR 15.0–33.25), significantly longer than in non-infected patients (p < 0.05). Multivariate analysis identified SOFA score as an independent predictor of ICU admission (OR 8.29, 95% CI 1.13–60.90, p = 0.038) and qSOFA score as a predictor of mortality (OR 8.67, 95% CI 1.41–53.29, p = 0.020). Conclusions: Postoperative nosocomial infections in this cohort were associated with high ICU admission rates, increased mortality, and prolonged hospitalization. Severity scores were strong prognostic markers, underscoring their utility for early risk stratification in surgical patients.