Postoperative mediastinitis in cardiac surgery — microbiology and pathogenesis

Gårdlund, Bengt; Bitkover, Catarina; Vaage, Jarle

doi:10.1016/s1010-7940(02)00084-2

Cited by 264 publications

(224 citation statements)

References 20 publications

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“…Our study also confirms that re-exploration of the chest 4,10,19) due to excessive postoperative bleeding or pericardial tamponade is also a serious and relevant risk factor leading to sternal wound dehiscence following cardiac surgery.…”

Section: Discussionsupporting

confidence: 85%

“…4,10,19) All of the surgical procedures were performed by any one of three senior surgeons using standard techniques. None of the patients in the study period suffered from low cardiac output.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,19) Allogeneic blood transfusion represents a possible risk for its recipients. The immunomodulation affects in-hospital morbidity and mortality, 7,8,17,19) increases the risk of infectious complications, [9][10][11][12]19) prolongs hospitalization, 11,13) and increases costs. The restrictive approach to allogeneic blood transfusion should always be adhered to, 19) and the guidelines for alternatives to blood transfusion should be followed.…”

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confidence: 99%

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Is Allogeneic Blood Transfusion a Risk Factor for Sternal Dehiscence Following Cardiac Surgery? A Prospective Observational Study

et al. 2009

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SummarySternal dehiscence following cardiac surgery has a multifactorial etiology. Significant risk factors contributing to sternal dehiscence include chronic obstructive pulmonary disease (COPD), obesity, or re-exploration due to bleeding or pericardial tamponade. We have focused on the role of allogeneic blood transfusion as a factor leading to the poor healing of surgical wounds.A prospective observational study of 1553 elective and emergency cardiac surgery patients was performed between January 2003 and June 2007. All of the patients enrolled in this study underwent median sternotomy. We studied the relationship between sternal dehiscence following cardiac surgery and the total number of packed red blood cells transfused.The incidence of sternal dehiscence in the study group was 3.4%. Diabetic patients did not have a higher incidence of wound dehiscence. Although COPD, 2) obesity, 2) and re-exploration 4) contributed to sternal dehiscence, the number of allogeneic blood transfusions during the perioperative period was an important independent risk factor for sternal dehiscence. Patients with sternal dehiscence received an average of 7.6 transfusion units (TU) of allogeneic blood versus 1.6 TU of allogeneic blood in the group without sternal dehiscence (P < 0.00005). The dehiscence affected patients without any other significant risk factor who received 6 or more TU, or patients with at least one significant risk factor who received 4 or more TU of allogeneic blood. According to our results, the total amount of allogeneic blood transfused is an important risk factor contributing to sternal dehiscence. Regardless of other risk preconditions, the transfusion of 6 or more TU could result in sternal dehiscence following cardiac surgery. (Int Heart J 2009; 50: 601-608)

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Is Allogeneic Blood Transfusion a Risk Factor for Sternal Dehiscence Following Cardiac Surgery? A Prospective Observational Study

et al. 2009

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“…Healing deficiency has been related to factors such as surgical wound infection, malnutrition, technical failure, considerable blood loss, and others 11 . Several authors have recognized that obesity hinders the healing process in a number of types of tissue [12][13][14] .Operations to repair incisional hernias range from simple syntheses to prosthesis. Sauerland et al 15 .…”

Section: Introductionmentioning

confidence: 99%

Obesity and abdominal wound healing in rats

et al. 2010

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Introduction: Treatment for obesity essentially has to do with weight loss, which can be achieved through surgical procedures. Despite the considerable rise in the number of such procedures, the relationship between obesity and the healing process has not been totally clarified. Purpose: To investigate abdominal wound healing in obese Wistar rats on the seventh and fourteenth days following a laparotomy. Methods: Thirty-six Wistar rats were randomly distributed into two groups, the control and experiment group. The control group were fed on either a standard diet for the species and the experiment group were put on a high calorie diet. After 116 days, all the animals were submitted to a laparotomy followed by laparorrhaphy. After euthanasia on the seventh or fourteenth day, fragments of the abdominal wound containing the scar were submitted to histopathological and tensiometric analysis. Results: The average weight of the animals from the experiment group was higher than that of the control group (p<0.001). The difference in the resistance of the cutaneous scars was not significant. The aponeurotic scars were more resistant in the control group after seven days (p=0.011) and fourteen days (p=0.040). There was no difference in terms of intensity of the inflammatory reaction and the collagen density was similar in both groups. Conclusion: In rats, obesity lowered the resistance of the aponeurotic scars but not the skin scars. It did not interfere with the delayed inflammatory response and the collagen density. Key words: Wound Healing. Obesity. Collagen. Rats. RESUMO Introdução:O tratamento da obesidade é baseado essencialmente na perda de peso, e isto pode ser conseguido por meio de procedimentos cirúrgicos. Apesar do grande aumento no número destes procedimentos, a relação entre obesidade e o processo de cicatrização ainda não está totalmente elucidada. Objetivo: Investigar a cicatrização da parede abdominal de ratos Wistar obesos, sete e 14 dias após laparotomia. Métodos: Ratos Wistar, em número de 36 foram alocados em dois grupos, controle e experimento. Os do grupo controle receberam dieta padrão para a espécie e os do experimento dieta hipercalórica. Depois de 116 dias, todos os animais foram submetidos à laparotomia seguida de laparorrafia. Após a eutanásia com sete ou 14 dias, fragmentos da parede abdominal contendo a cicatriz receberam análise histopatológica e tensiométrica. Resultados: O peso médio dos animais do grupo experimento foi maior do que o do grupo controle (p<0,001). A diferença da resistência das cicatrizes cutâneas não foi significante. As cicatrizes aponeuróticas foram mais resistentes no grupo controle aos sete dias (p=0,011) e aos 14 dias (p=0,040). Não houve diferença quanto à intensidade da reação inflamatória e a densidade de colágeno foi semelhante nos dois grupos. Conclusão: Em ratos, a obesidade diminuiu a resistência das cicatrizes aponeuróticas, mas não a das cicatrizes da pele. Não interferiu na reação inflamatória tardia e nem na densidade do colágeno. Descritores: Cica...

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“…16) Postoperative mediastinitis developed after 126 (1.32%) of 9557 consecutive cardiac surgery operations. In the case of cardiac surgery, S. aureus and coagulase-negative staphylococci are the most commonly isolated organisms, 17) and proper antibiotic prophylaxis reduces the incidence of SSI. Hence, the choice of antibiotic, as well as the dose, timing and duration of prophylaxis, is important.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Prophylactic Ampicillin–Sulbactam and Dosing Optimization in Patients Undergoing Cardiovascular Surgery with Cardiopulmonary Bypass

Yokoyama

Matsumoto

Ikawa

et al. 2015

Biological & Pharmaceutical Bulletin

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Antibiotic concentrations must be maintained at an adequate level throughout cardiovascular surgery to prevent surgical site infection. This study aimed to determine the most appropriate timing for intraoperative repeated dosing of ampicillin-sulbactam, a commonly used antibiotic prophylaxis regimen, to maintain adequate concentrations throughout the course of cardiovascular surgery with cardiopulmonary bypass (CPB). The total plasma concentrations of ampicillin were monitored in 8 patients after ampicillin (1 g)-sulbactam (0.5 g) administration via initial intravenous infusion and subsequent CPB priming. Pharmacokinetic parameters were estimated and used to predict the free plasma concentrations of ampicillin. The mean values for the volume of distribution, elimination rate constant, elimination half-life, and total clearance of ampicillin were 15.8 4.1 L, 0.505 0.186 h 1 , 1.52 0.47 h, and 7.72 2.72 L/h, respectively. When ampicillin (1 g)-sulbactam (0.5 g) was intravenously administered every 3, 4, 6, and 12 h after the start of CPB, the predicted free trough plasma concentrations of ampicillin were 15.20, 8.25, 2.74, and 0.13 µg/mL, respectively. Therefore, an every-6-h regimen was needed to maintain the free ampicillin concentration at more than 2 µg/mL during cardiovascular surgery with CPB. We suggest that the dose and dosing interval for ampicillin-sulbactam should be adjusted to optimize the efficacy and safety of treatment, according to the minimum inhibitory concentrations for methicillin-sensitive Staphylococcus aureus isolates at each institution. Registration number: UMIN000007356.Key words ampicillin; sulbactam; cardiovascular surgery; prophylaxis; cardiopulmonary bypass The United States Centers for Disease Control National Nosocomial Infections Surveillance system demonstrated that surgical site infection (SSI) is the most frequently reported nosocomial infection, accounting for 14-16% of such infections among hospitalized patients and 38% in surgical patients.1) According to the Japan Nosocomial Infections Surveillance Open Report 2013, the incidence of SSI in cardiovascular surgery was 1.5-4.8%. 2)Postoperative SSIs are a major cause of postoperative morbidity and mortality in patients undergoing cardiac surgery. SSIs of the sternal wound and underlying mediastinum occur in 0.4-4% of cardiac surgical operations.3) The administration of antibiotic prophylaxis in patients treated with cardiothoracic operations can reduce the rate of SSI, and placebo-controlled trials of cardiothoracic antibiotic prophylaxis have found a benefit in preventing postoperative wound infections. 4)Cardiopulmonary bypass (CPB) is a technique that is nearly exclusively used by cardiac surgeons and has profound effects on the volume of distribution (V d , L) and elimination kinetics for a variety of drugs, including commonly used antibiotic prophylaxis agents.3) Antibiotic prophylaxis should be selected according to the type of surgery, with administration starting within 60 min of the skin incision. When the duration of...

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Postoperative mediastinitis in cardiac surgery — microbiology and pathogenesis

Cited by 264 publications

References 20 publications

Is Allogeneic Blood Transfusion a Risk Factor for Sternal Dehiscence Following Cardiac Surgery? A Prospective Observational Study

Is Allogeneic Blood Transfusion a Risk Factor for Sternal Dehiscence Following Cardiac Surgery? A Prospective Observational Study

Obesity and abdominal wound healing in rats

Pharmacokinetics of Prophylactic Ampicillin–Sulbactam and Dosing Optimization in Patients Undergoing Cardiovascular Surgery with Cardiopulmonary Bypass

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