Deep sternal wound infection after cardiac surgery in the Chinese population: a single-centre 15-year retrospective study

Abstract

Background: Deep sternal wound infection (DSWI) is a severe complication following cardiac surgery. A retrospective study was implemented to determine the risks and clinical characteristics of DSWI after cardiac operation in the Chinese population.Methods: We analysed 7,944 consecutive patients who underwent cardiac surgery via median sternotomy from January 2002 to December 2016 at our institution. Multiple logistic regression analysis was used to identify risk factors for DSWI.Results: A total of 106 patients (1.33%) suffered from DSWI; significant risk factors included body mass index (BMI) (P=0.02; OR=1.08; 95% CI: 1.01-1.16) and reoperation (P<0.01; OR=5.93; 95% CI: 2.88-12.25).The most common bacterium involved in DSWI was staphylococcus aureus (23%). Among all DSWI patients, the overall survival rate of the group treated with flap reconstruction was significantly higher than that in the group treated with intravenous antibiotics and sternal debridement (87% vs. 59%, P=0.01).Conclusions: DSWI was associated with several risk factors. Effective intervention strategies could improve the outcome of patients undergoing cardiac surgery.

Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland

“…Over the following decade, this increased vigilance led to an overhaul of local antimicrobial practice away from the prescription of broad-spectrum antimicrobials, especially cephalosporin and quinolone antimicrobials (Lee et al, 2019). This is particularly pertinent in cardiac surgery because of the diverse range of organisms that are associated with SSIs (Chaudhuri et al, 2012; Cooper et al, 2019; Ma and An, 2018; Moinipoor et al, 2013; Pan et al, 2017). Ma and An (2018) reviewed deep sternal wound infections in their centre between 2011 and 2015, identifying 170 patients that had clinical DSWIs.…”

“…This highlights the importance of ensuring broad-spectrum antimicrobial prophylaxis in cardiac surgery includes both gram-negative and gram-positive activity (Lador et al, 2012). It is however likely that the specific organisms causing SSI is likely to change between centres within the UK and ROI and certainly across the globe (Kotnis-Gaska et al, 2018; Lin et al, 2003; Ma and An, 2018; Moinipoor et al, 2013; Pan et al, 2017). It is therefore essential that antimicrobial regimens are tailored to local microbial epidemiology (NICE, 2019).…”

“…Surgical site infection (SSI) remains a costly complication of cardiac surgery (Findeisen et al, 2018; Graf et al, 2010), with an incidence in the range of 1.3%–7.9% (Figuerola-Tejerina et al, 2016; Mannien et al, 2011; Pan et al, 2017). It has been demonstrated to increase the hospital length of stay by up to two weeks (Graf et al, 2010; Joshi et al, 2016), readmission rates sixfold (Joshi et al, 2016) and the risk of mortality up to tenfold (Andrade et al, 2019).…”

Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center

“…Deep sternal wound infection (DSWI) following median sternotomy is a life-threatening complication after this approach for coronary artery bypass grafting (CABG). 1 2 Most of the patients who undergo CABG have associated morbidities such as diabetes mellitus resulting in delayed wound healing. The incidence of sternal wound infections and dehiscence is reported between 0.2 and 10% among patients who undergo sternotomy and mortality of 5 to 20% following sternal dehiscence.…”

Management of Deep Median Sternotomy Wound Infection after Open Heart Surgery

“…There is a progress in deep sternal wound infection management in the last 50 years. Deep median sternotomy wound infection treatment must be individualized based on the depth of the infection, the organisms that are cultured, and the patient's clinical status (7) .…”