Preventing deep wound infection after coronary artery bypass grafting: a review (original) (raw)
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Journal of Clinical Trials in Cardiology, 2018
Objective: To determine the incidence and predictor of postoperative wound infection in patients underwent coronary artery bypass grafting (CPB). Methods: This was a prospective comparative study of 577 patients who underwent cardiac surgery with (CPB) was conducted at cardiac surgery department of Punjab Institute of cardiology, Lahore from 1st March 2012 to 31st March 2017. Consecutive patients undergoing elective and isolated CABG, both genders age ≥20 years, with normal ejection fraction were included in the study Results: Out of 577 patients of which 166(87.83%) were male while 23(12.16%) were female. The mean age of the patient was 53.23 ± 8.43. Incidence of post-operative wound infection in patients underwent coronary artery bypass grafting (CPB) was 73(12.65%). Common co morbid conditions were hypertension 50%, diabetes mellitus (43.5%), smoking (31.1%), hyperlipidemia (20.3%), prior of stoke (12.2%), Prior Surgery (6.8%) and prior renal failure (4.1%), mean CPB time (61.69 ± 32.27), ICU stay 976.03 ± 31.93), mean Cross clamp time(25.27 ± 19.17mg/dl) and Hospital stay (10.16 ± 5.6 day) were more in WI group. Themortality was found to be high in WI group (23.3%). Logistic regression showed that significantly predicted of the post-operative WI were elder age,diabetes mellitus, smoking, family history of IHD, hyperlipidemia, cardiopulmonary bypass time, ICU stay, hospital stay. Conclusion: We can conclude that wound infected patients are at significantly greater risk of incidence, morbidity and mortality after cardiac surgery.
The Journal of thoracic and cardiovascular surgery, 2017
To analyze patient risk factors and processes of care associated with secondary surgical-site infection (SSI) after coronary artery bypass grafting (CABG). Data were collected prospectively between February and October 2010 for consenting adult patients undergoing CABG with saphenous vein graft (SVG) conduits. Patients who developed a deep or superficial SSI of the leg or groin within 65 days of CABG were compared with those who did not develop a secondary SSI. Among 2174 patients identified, 65 (3.0%) developed a secondary SSI. Median time to diagnosis was 16 days (interquartile range 11-29) with the majority (86%) diagnosed after discharge. Gram-positive bacteria were most common. Readmission was more common in patients with a secondary SSI (34% vs 17%, P < .01). After adjustment, an open SVG harvest approach was associated with an increased risk of secondary SSI (adjusted hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.28-3.48). Increased body mass index (adjusted HR,...
Serious wound infections after minimally invasive coronary bypass procedures
The Annals of Thoracic Surgery, 1998
Background. Minimally invasive coronary artery bypass grafting has become an increasingly accepted therapy for selected patients with single-vessel coronary artery disease. Reported morbidity has focused on anastomotic problems, but the occurrence of serious wound complications after these procedures has not been well documented.
Journal of International Medical Research
Objective: Surgical site infection (SSI) is a serious complication after coronary artery bypass grafting (CABG). This study was performed to evaluate evidence-based practice and structured problem-solving to reduce SSI after CABG. Methods: An infection control strategy including supervised chlorhexidine gluconate (CHG) showers was implemented from January 2017 to March 2018 for 119 patients undergoing CABG. The controls comprised 244 patients who underwent CABG from 2014 to 2016. Risk factors for SSI were identified, and a problem-focused strategy was used to control SSI. Propensity score matching was used to study the effect of CHG showers on SSI. Results: SSI occurred in 25 patients (10.25%) in the control group, and the significant risk factors were the postoperative blood glucose level, transfer from an outside hospital, emergency operation, redo sternotomy, a higher American Society of Anesthesiologists score, and the duration
A fifteen-year wound surveillance study after coronary artery bypass
Annals of Thoracic Surgery, 1993
Wound infections after coronary artery bypass operations have been continuously monitored at the Minneapolis Veterans Affairs Hospital for 15 years. All patients were followed up for 30 days. From 1977 to 1991, 2,402 coronary artery bypass operations were performed, and wound infections developed in 125 (5%) patients. There were 71 (3%) chest infections of which 33 (1.4%) were major and 38 (1.6%) superficial. Greater than 94% of these grew only a single organism, of which 74% were StuphyZococcus species. There were 63 (2.6%) leg wound infections. More than 50% of these grew multiple organisms, of which 68% were enteric in origin. Nine (0.4%) patients had simultaneous chest and leg infections.
Survey of Preoperative Infection Prevention for Coronary Artery Bypass Graft Procedures
Infection Control & Hospital Epidemiology, 2014
Approximately 400,000 coronary artery bypass graft (CABG) procedures are performed annually in the United States. 1 Surgical site infections (SSI) complicate 3-5% of CABG procedures and result insignificant attributable mortality. 2-4 Studies show that surgical preparation with chlorhexidine is more effective than povidone-iodine in reducing bacterial colony counts and lowering SSI. 5-8 In addition to surgical preparation, the use of clippers or a chemical depilatory for hair removal has a lower SSI rate than the use of razors. 8,9 To better understand compliance with established standards of care, we conducted a survey of pre-operative surgical practices used prior to isolated CABG surgery among hospitals in California. We utilized the survey data to calculate an estimate of excess infections and mortality from non-compliance with practice standards. Methods We developed a web-based survey for all 120 California medical centers that perform CABG surgery. The survey asked about pre-operative bathing, surgical preparation, dressing management, and antibiotic prophylaxis for isolated CABG. Questions relating to surgical preparation and hair removal included: i) what do you most commonly use for surgical preparation, usually given in the operating room immediately prior to CABG; ii) what method is most commonly used for hair removal prior to CABG, iii) who receives preoperative bathing, iv) what is the location of the pre-operative bath, and v) what is used for pre-operative bathing. We collected descriptive information on individual hospitals,
American Journal of Infection Control, 2009
Background: Our goals were to evaluate the risk factors predisposing to saphenous vein harvest surgical site infection (HSSI), the microbiology implicated, associated outcomes including 30-day mortality, and identify opportunities for prevention of infection. Methods: All patients undergoing coronary artery bypass grafting (CABG) procedures from January 2000 through September 2004 were included. Data were collected on preoperative, intraoperative, and postoperative factors, in addition to microbiology and outcomes. Results: Eighty-six of 3578 (2.4%) patients developed HSSI; 28 (32.6%) of them were classified as deep. The median time to detection was 17 (range, 4-51) days. An organism was identified in 64 (74.4%) cases; of them, a single pathogen was implicated in 50 (78%) cases. Staphylococcus aureus was the most frequently isolated pathogen: 19 (38% [methicillin-susceptible S aureus (MSSA) 5 12, methicillinresistant S aureus (MRSA) 5 7]). Gram-negative organisms were recovered in 50% of cases, with Pseudomonas aeruginosa predominating in 11 (22%) because of a single pathogen. Multiple pathogens were identified in 14 (22%) cases. The 30-day mortality was not significantly different in patients with or without HSSI. Multivariate analysis showed age, diabetes mellitus, obesity, congestive heart failure, renal insufficiency, and duration of surgery to be associated with increased risk. Conclusion: Diabetes mellitus, obesity, congestive heart failure, renal insufficiency, and duration of surgery were associated with increased risk for HSSI. S aureus was the most frequently isolated pathogen.
Razavi International Journal of Medicine, 2021
Introduction: Surgical site infection is a risky complication following coronary artery bypass graft (CABG) surgery that may increase mortality and morbidity. Hence, it seems that further investigation regarding this complication may be necessary, in order to improve prevention and treatment processes. Objectives: The aim of this study was to determine the frequency of sternal wound infection and saphenous vein wound infection in patients undergoing CABG and its correlation with the determinants. Methods: This is a cross-sectional study that was undertaken from 2015 to 2019 on 2459 patients undergoing CABG surgery with off-pump and on-pump methods. Demographic and background information of our patients were recorded. After infection, secretions were sampled and cultured. Results: Results of the study showed that the frequency of sternal and saphenous harvesting site infection in patients was 3.7% (n=91), and these infections were often diagnosed two weeks after surgery (50 patients, 54.9%). Age and sex were identified as two significant risk factors of surgical site infection after CABG surgery (p=0.0001). Most patients came back with an infection two weeks after surgery (54.9%). Gram-positive bacteria had the greatest role in infection (35.2%) with Staphylococcus epidermidis acting as the predominant strain (n=13). Discussion and Conclusion: The results suggested that two factors with a crucial role in the incidence of infection, are female gender and age of 50-60 years old. Diabetes, previously identified in the literature as a risk factor for surgical site infection, did not have a significant effect in this study and further research is warranted.