Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data (original) (raw)
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Purpose: Surgical site infection (SSI) is an important cause of morbidity and occasional mortality following open heart surgery. The aim of this study is to find out the incidence of surgical site infections in patients undergoing open heart surgery, the organisms responsible and the risk factors associated with such infections. Patients and Methods: Consecutive patients undergoing open heart surgery between June2014 and December2015 have been included for study. The exclusion criteria being age less than 30 years, penicillin/ cephalosporin allergy and any other associated systemic infections the parameters studied were age, sex, obesity, hypertension, diabetes, and myocardial infarction, length of pre and postoperative hospital stay and duration of surgery. Suspected sites of infection were cultured. Postoperative follow up was done every month for six months. Results: One hundred thirty five patients who had median sternotomy for open heart surgery have been studied. Seventeen patients (12.59%) developed surgical site infection (SSI) infection (superficial sternal wound infection and leg wound infections) and all got cured with conservative management Organisms isolated at SSI were Staphylococcus aureus-7(41.17%), Escherichia coli-3 (17.6%),Coagulase negative Staphylococcus-2(11.76%), Klebsiella pneumoniae 2 (11.76%) , Pseudomonas aeruginosa-2 (11.76%) and Proteus species-1 (5.8%). Surgical site infection has increased the postoperative hospital stay and the total treatment cost. Conclusions: The incidence of surgical site infections in this centre was comparable with other studies from India as well as abroad. Surgical site infection may occur due to non Staphylococcus aureus organisms. Uncontrolled diabetes mellitus and male sex are associated with higher infection rates.
European Journal of Cardio-Thoracic Surgery, 2003
Objective: To identify risk factors for sternal wound infection following coronary artery bypass surgery (CABG), and to compare early and mid-term survival outcome. Methods: Data were prospectively collected for 4228 patients who underwent CABG surgery between April 1997 and March 2001. One hundred and nine (2.6%) patients developed sternal wound infection. We used logistic regression to identify independent risk factors associated with post-operative sternal wound infection. Patient records were linked to the National Strategic Tracing Service, which records all deaths in the UK, to establish current vital status. Deaths occurring over time were described using Kaplan-Meier techniques. To control for differences in patient characteristics, we used Cox proportional hazards analysis to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results: The results of the logistic regression analysis found that the independent predictors of sternal wound infection were obesity (odds ratio (OR) 2.0; P , 0:001), New York Heart Association class $ 3 (OR 1.6; P ¼ 0:022), use of bilateral internal mammary arteries (OR 3.2; P , 0:001), increasing number of grafts (OR 1.5; P , 0:001), re-exploration for bleeding (OR 3.1; P ¼ 0:011), and increased duration of mechanical ventilation (for every 10 h (OR 1.12; P , 0:001)). Three hundred and forty one (8.1%) deaths occurred during the study period with mean follow up of 3.2^1.3 years. The crude HR of mid-term mortality for sternal wound infection patients was 2.51 (95% CI 1.59-3.94, P , 0:001). After adjustment for pre, intra and post-operative factors, the adjusted HR of mid-term mortality for sternal wound infection patients was 1.64 (95% CI 1.03-2.61, P ¼ 0:037). The adjusted freedom from death for sternal wound infections at 30 days, and 1, 2 and 4 years was 96.8, 93.7, 91.4 and 86.7%, respectively, compared with 98.1, 96.1, 94.7 and 91.7% for patients without sternal wound infections. Conclusions: In conclusion, we have identified risk factors for sternal wound infection, many of which are modifiable. We have also shown that there is a significant increase in mortality in patients with sternal wound infection during a 4-year follow-up period after CABG.
Incidence, types and outcomes of sternal wound infections after cardiac surgery in Saudi Arabia
Saudi Medical Journal, 2020
The proforma contained personal data, comorbidities, type of surgery, microbiological analysis, and management outcomes. Original Article Results: A total of 1241 patients were enrolled in the study comprising 1,032 (83.2%) men and 209 (16.8%) women. Forty (3.2%) patients developed SWI, of which 32 (2.5%) were superficial and 8 (0.7%) were deep. Gender, obesity, diabetes mellitus, non-use of statins, and coronary artery bypass graft (CABG) surgery were not significant predictors of infection in the study. Methicillin-susceptible Staphylococcus aureus was isolated predominantly in 45%, followed by Klebsiella and Pseudomonas species. Methicillin-resistant Staphylococcus aureus, Enterococcus faecium, and extended β-lactamaseproducing gram-negative organisms were pathogens isolated in last 3 years of the review. Simple and vacuum assisted closure therapies led to complete resolution in 32 (80%) patients, while 8 (20%) developed sternal osteomyelitis. All patients survived except one with a deep SWI who died of uncontrolled sepsis. Conclusion: Despite the low incidence of postoperative SWIs, the risk of sternal osteomyelitis development persists. Meticulous choice of CABG components and appropriate postoperative management, especially detecting early signs of SWI could contribute to lower its incidence and complications.
Journal of Hospital Infection, 2005
Florence Nightingale Hospital is a 300-bed, university-affiliated, private medical centre with a large open heart surgery programme in Istanbul, Turkey. In this study, the mortality rates, lengths of stay (LOS) and extra costs of patients with deep sternal surgical site infections (DSSSIs) and superficial sternal surgical site infections (SSSSIs) following coronary artery bypass grafting (CABG) were determined from January 1999 to December 2002. Group I included 52 patients with DSSSIs, Group II included 36 patients with SSSSIs and Group III included 88 controls. The controls were selected at random from patients operated within the same year, with the same sex and age within five years, but who had not developed infection. Mortality rates in Groups I, II and III were 19.2%, 0% and 4.5%, respectively; the mortality rate in Group I was significantly different from that in Groups II and III (P!0.005). LOS was 47, 33 and 12 days for Groups I, II and III, respectively, and LOS was statistically different for each group (P!0.005). The costs of extra LOS, antibiotics, and radiological, microbiologial and other laboratory examinations for Groups I and II were US$6850.93 and US$3740.58, respectively. Both DSSSI and SSSSI following CABG extended the LOS and increased the cost, and DSSSI was significantly associated with a high mortality rate. These results suggest the need for improved infection control measures to reduce
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. Objective: 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, 5...