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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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