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Sternal Surgical-Site Infection Following Coronary Artery Bypass Graft Prevalence, Microbiology, and Complications During a 42-Month Period

Published online by Cambridge University Press:  02 January 2015

Mamta Sharma ,
Dorine Berriel-Cass  and
Joseph Baran Jr.
Mamta Sharma*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan
Dorine Berriel-Cass
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan
Joseph Baran Jr.
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, St. John Hospital and Medical Center, Detroit, Michigan
*
Medical Education, St. John Hospital and Medical Center, 22101 Moross Road, Detroit, Ml 48236
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Abstract

Objective:

Surgical-site infection (SSI) is a serious and costly complication following coronary artery bypass graft (CABG). We analyzed surgical factors, microbiology, and complications at a 608-bed community teaching hospital to identify opportunities for prevention.

Methods:

All patients undergoing CABG procedures from June 1997 through December 2000 were analyzed. Hospital records and postdischarge surveillance data were reviewed for demographics, surgical information, timing and classification of infection, microbiology, and bacteremic events.

Results:

Of 3,443 patients undergoing CABG, sternal SSI developed in 122 (3.5%); 71 (58.2%) were classified as superficial SSI and 51 (41.8%) as deep SSI. Surgical antimicrobial prophylaxis was employed in all cases. On average, infection occurred 21.5 days (range, 4 to 315) after CABG. Most cases were diagnosed on readmission (59%); 20 cases (16%) were identified by postdischarge surveillance. Microbiological data were positive in 109 (89.3%), with a single pathogen implicated in most (86.2%). Gram-positive cocci were most frequently recovered (81%); gram-negative bacilli (17%), gram-positive bacilli (1%), and yeast (1%) were less common. Staphylococcus aureus was the most frequently isolated pathogen (49%). Bacteremia was noted in 22 instances (18%). It was significantly associated with deep SSI (P =. 002) and identified only in S. aureus cases.

Conclusions:

SSI complicated 3.5% of the procedures. S. aureus was implicated in most of the cases and was significantly associated with deep SSI. It was the only pathogen associated with secondary bacteremia. In addition to standard guidelines, targeted methods against S. aureus should help reduce the overall rate of SSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 6 , June 2004 , pp. 468 - 471
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Loop, FD, Lytle, BW, Cosgrove, DM, et al.Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thome Surg 1990;49:178–187.Google Scholar
2.Ottino, G, Paulis, RD, Pansini, S, et al.Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg 1987;44:173–179.Google Scholar
3.Kohlman, LJ, Coleman, MJ, Parker, FB Jr. Bacteremia and sternal infection after coronary artery bypass grafting. Ann Thorac Surg 1990;49:454–457.Google Scholar
4.Mossad, SB, Serkey, JM, Longworth, DL, Cosgrove, DM III, Gordon, SM. Coagulase-negative staphylococcal sternal wound infections after open-heart operations. Ann Thome Surg 1997;63:395–401.Google Scholar
5.Stahle, E, Tammelin, A, Bergstrom, R, Hambreus, A, Nystrom, SO, Hansson, HE. Sternal wound complication: incidence, microbiology and risk factors. Eur J Cardiothorac Surg 1997;11:1146–1153.CrossRefGoogle ScholarPubMed
6.Blanchard, A, Hurni, M, Ruchat, P, Stumpe, F, Fischer, A, Sadeghi, H. Incidence of deep and superficial sternal infection after open heart surgery: a ten years retrospective study from 1981 to 1991. Eur J Cardiothorac Surg 1995;9:153–157.Google Scholar
7.Zacharias, A, Habib, RH. Factors predisposing to median sternotomy complications: deep vs superficial infection. Chest 1996;110:1173–1178.Google Scholar
8.Farinas, MC, Gald Peralta, F, Bernal, JM, Rabasa, JM, Revuelta, JM, Gonzalez-Macias, J. Suppurative mediastinitis after open-heart surgery: a case-control study covering a seven-year period in Santander, Spain. Clin Infect Dis 1995;20:272–279.Google Scholar
9.Borger, MA, Rao, V, Weisel, RD, et al.Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998;65:1050–1056.Google Scholar
10.Demmy, TL, Park, SB, Liebler, GA, et al.Recent experience with major sternal wound complications. Ann Thome Surg 1990;49:458–462.Google Scholar
11.Parisian Mediastinitis Study Group. Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 1996;111:1200–1207.CrossRefGoogle Scholar
12.Verkkala, K. Occurrence of and microbiological findings in postoperative infections following open-heart surgery: effect on mortality and hospital stay. Ann Clin Res 1987;19:170–177.Google Scholar
13.Spelman, DW, Russo, P, Harrington, G, et al.Risk factors for surgical wound infection and bacteremia following coronary artery bypass surgery. Australian and New Zealand Journal of Surgery 2000;70:47–51.Google Scholar
14.Munoz, P, Menasalvas, A, Bernaldo de Quiros, JCL, Desco, M, Vallego, JL, Bouza, E. Postsurgical mediastinitis: a case-control study. Clin Infect Dis 1997;25:1060–1064.Google Scholar
15.Sofer, D, Gurevitch, J, Shapira, I, et al.Sternal wound infections in patients after coronary artery bypass grafting using bilateral skeletonized internal mammary artery. Ann Surg 1999;4:585–590.Google Scholar
16.Bitkover, CY, Gardlund, B. Mediastinitis after cardiovascular operations: a case-control study of risk factors. Ann Thorac Surg 1998;65:36–40.Google Scholar
17.Wang, FD, Chang, CH. Risk factors of deep sternal wound infection in coronary artery bypass graft surgery. J Cardiovasc Surg 2000;41:709–713.Google Scholar
18.He, GW, Ryan, WH, Acuff, TE, et al.Risk factors for operative mortality and sternal wound infection in bilateral internal mammary artery grafting. J Thorac Cardiovasc Surg 1994;107:196–202.Google Scholar
19.Milano, CA, Kesler, K, Archibald, N, Sexton, DJ, Jones, RH. Mediastinitis after coronary artery bypass graft surgery: risk factors and long-term survival. Circulation 1995;92:2245–2251.Google Scholar
20.El Oakley, R, Paul, E, Wong, PS, et al.Mediastinitis in patients undergoing cardiopulmonary bypass: risk analysis and midterm results. J Cardiovasc Surg 1997;38:595–600.Google Scholar
21.Nagachinta, T, Stephens, M, Reitz, B, Polk, BE. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 1987;156:967–973.Google Scholar
22.L'Ecuyer, PB, Murphy, D, Little, JR, Fraser, VJ. The epidemiology of chest and leg wound infections following cardiothoracic surgery. Clin Infect Dis 1996;22:424–429.Google Scholar
23.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hasp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
24.Galbut, DL, Ernest, TA, Malcolm, DJ, et al.Seventeen-year experience with bilateral internal mammary artery grafts. Ann Thorac Surg 1990;49:195–201.Google Scholar
25.Bellchambers, J, Harris, JM, Cullman, P, Gaya, H, Pepper, JR. A prospective study of wound infection in coronary artery surgery. Eur J Cardiothorac Surg 1999;15:45–50.CrossRefGoogle ScholarPubMed
26.Brook, I. Microbiology of postthoracotomy sternal wound infection. J Clin Microbiol 1989;27:806–807.Google Scholar
27.Kluytmans, JA, Mouton, JW, Ijzerman, EPF, et al.Nasal carriage of Staphylococcus aureus as a major risk factor for wound infection after cardiac surgery. J Infect Dis 1995;171:216–219.Google Scholar
28.Kluytmans, JA, Mouton, JW, Marjolein, FQ, et al.Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 1996;17:780–785.Google Scholar
29.Perl, TM, Cullen, JJ, Wenzel, RP, et al.Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:1871–1877.Google Scholar