No abstract

Relevanc. Surgical Site Infection (SSI) after open heart surgery is a significant problem in clinical, social, and economic aspect which causes the need to identification of the preferred procedures for successful prevention of the SSI.Objectives. To determine risk of the SSI in cardiac surgery depending on complexity of intervention, using of cardiopulmonary bypass (CBP) and use of both internal mammary arteries (IMA).Methods. Prospective observations study from 2010 to 2019 in cardiac surgery department of the Ural Institute of Cardiology, where in total 4993 open heart surgery procedures were consecutively performed. All SSI cases were recorded up to 90 days after surgery. The analysis was performed to identify risk of cardiopulmonary bypass (CPB), bilateral IMA grafting and combined procedures on the risk of the postoperative wound infection.Results. During the investigation period, total 220 cases of the SSI (4,5%) have been registered of the 4993 patients undergoing open heart surgery. It included 42 cases of deep sternal infection (0,9%) and 178 cases of superficial infection (3,6%). The main pathogen identified was Staphylococcus epidermidis (56,4%). During the hospital period, 151 cases (66,5%) of SSI have been detected, with the median time to detection of the complication 6 days. The relative mortality risk in deep sternal infection group was 4,4 times higher than in the group without SSI (HR 4,6, 95 % CI 1,5-13,9, p=0,003624). CABG increases the relative risk of SSI in compare with non-CABG procedures (OR 3,086169; 95%CI 1,281 – 7,437), while the complexity of the operation (combined versus isolated interventions) does not significantly increase the risk (OR 0.972283; 95% CI: 0.696 - 1.359). The incidence of SSI in the group of in situ BIMA grafting was 8.8%, significantly increasing the likelihood of the SSI in compare to those with SIMA (OR 2.167983, 95% CI 1.463 - 3.212; p =0,000057). CBP significantly increases the risk of postoperative wound infections (OR 1.523890, 95% CI 1.149 - 2.022, p = 0.001742).Conclusions. Refusal of cardiopulmonary bypass, simultaneous procedures and bilateral coronary artery bypass does not allow completely to avoid postoperative wound infections. Nevertheless, the technical features of the preparations and use of grafts, including skeletonization, prevention of coagulation and the preference for sequential composite CABG, can reduce the risk associated with the type of the open heart surgery.

Relevance. Infectious complications arising in the postoperative period (nosocomial infections) have an adverse effect on the results of high-tech interventions in a cardiac surgery clinic, worsening clinical results and being a significant article of medical expenses. Aims. To analyze modern literature data on the prevalence of nosocomial infections after high-tech cardiac surgery to identify factors that affect its variability. Conclusions. The prevalence of hospital Infectious complications after cardiac surgery remains high, ranging, according to various sources, from 0.9% to 35%. The deep form, accompanied by a significant mortality rate, is more common in the range from 0.4% to 5%, the incidence of superficial forms is much more variable, leaving from 1.5% to 30%. A prerequisite for controlling infection in a cardiac surgery hospital is thorough and adequate registration of such complications. Conducting a dynamic comparison of the prevalence of nosocomial infections in the process of epidemiological control requires the consistent use of unchanged methods of statistical analysis, constant criteria for determining a standard case and the use of up-to-date classifications. An important step in the study of the prevalence of nosocomial infections is to provide the obtained information to practicing physicians in order to maintain a high level of awareness of the effectiveness of treatment and prevention.

Инфекционные осложнения, развившиеся после кардиохирургических вмешательств, ухудшают здоровье пациента и увеличивают стоимость лечения. Учет факторов риска инфекции области хирургического вмешательства на догоспитальном, интраоперационном, послеоперационном этапах оказания помощи уменьшает частоту осложнений. К модифицируемым факторам риска относятся гипергликемия, нарушение питания, депрессия, курение и употребление алкоголя, продолжительность предоперационного койко-дня, наличие кожных инфекций и колонизация носоглотки S. aureus, наличие сердечной недостаточности, нарушение протокола антимикробной профилактики, неправильная обработка операционного поля, неверный выбор тактики шунтирования, проблемы операционного доступа и закрытия операционного поля, анемия, неадекватная оксигенация, нарушение нормотермии, продленная интубация и катетеризация, а также организационные факторы в медицинском учреждении. Применение современных рекомендаций способствует нивелированию отрицательного влияния этих факторов на развитие инфекции области хирургического вмешательства.Финансирование. Исследование не имело спонсорской поддержки.Конфликт интересов. Автор заявляет об отсутствии конфликта интересов.Для цитирования: Степин А.В. Модифицируемые факторы риска и современные подходы к профилактике инфекции области хирургического вмешательства в кардиохирургии // Клиническая и экспериментальная хирургия. Журнал имени академика Б.

No abstract