Incidence, types and outcomes of sternal wound infections after cardiac surgery in Saudi Arabia

Abstract

Objectives: To determine the incidence, types, risk factors, identify organisms, and assess outcomes of surgical wound infections (SWIs) after cardiac surgery at a tertiary hospital in Riyadh, Saudi Arabia. Methods: This historical cohort study reviewed the chart of patients who underwent cardiac surgery at King Khalid University Hospital, Riyadh, Saudi Arabia between January 2009 and December 2014. The proforma contained personal data, comorbidities, type of surgery, microbiological analysis, and management outcomes. 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-lactamase-producing 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.

Impact of Pre-operative Hemoglobin A1C Level and Microbiological Pattern on Surgical Site Infection After Cardiac Surgery

“…In our study, the incidence of all types of SSI after cardiac surgery was quite high (29.3%). Fortunately, deep infection and osteomyelitis were low (5.7% and 1.3%, respectively), which is consistent with the numbers in the literature [3,5,16]. Interestingly, in our cohort, there was a higher incidence of gram-negative induced infections compared to gram-positive (43% vs. 25.4%).…”

“…This is quite different from the published literature where gram-positive induced infections are predominant [2][3][4][5][6]17]. In a locally conducted retrospective cohort study by Al Majid et al in Riyadh, with 1241 adult patients who underwent cardiac surgery in a singlecenter, the incidence of SSI was 3.2% with 45% of infections due to methicillin-susceptible Staphylococcus aureus [5]. They found that neither gender, obesity, diabetes mellitus, non-use of statins, nor CABG surgery were significant predictors of infection.…”

“…Interestingly, in our cohort, there was a higher incidence of gram-negative induced infections compared to gram-positive (43% vs. 25.4%). This is quite different from the published literature where gram-positive induced infections are predominant [2][3][4][5][6]17]. In a locally conducted retrospective cohort study by Al Majid et al in Riyadh, with 1241 adult patients who underwent cardiac surgery in a singlecenter, the incidence of SSI was 3.2% with 45% of infections due to methicillin-susceptible Staphylococcus aureus [5].…”

“…SSI after cardiac surgery has been associated with major morbidities and up to a 25% risk of mortality [1,2,5,6]. Even though cardiac surgery is classified as a "clean procedure" because there is no involvement of visceral organs, there is still a high incidence of SSI occurring after cardiac surgery.…”

“…Even though cardiac surgery is classified as a "clean procedure" because there is no involvement of visceral organs, there is still a high incidence of SSI occurring after cardiac surgery. This may be attributed to the patient-related factors and the presence of co-morbidities (diabetes, hypertension, renal diseases, dyslipidemia, obesity) [5,[7][8][9]. Many studies have found diabetes to be a significant contributor and a risk factor for SSI.…”