Preoperative carriage and postoperative same-species sternal wound infection after cardiac surgery

Abstract

Sternal wound infection (SWI) after cardiac surgery remains an important problem. Prediction of pathogens involved in such infection could guide antibiotics. From April 1, 2006 to December 31, 2008, retrospectively, we evaluated the diagnostic value of preoperative methicillin-sensible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or multi-drug resistant Gram-negative bacillus (MDRGNB) carriage to predict same-pathogens involved in postoperative SWI. All patients referred for elective cardiac surgery were screened using multisite (nares, axillae, rectal) sampling at admission to detect MSSA, MRSA, and MDRGNB. Of the 1895 patients addressed, 425 patients (22.4%) were colonized at admission. Preoperative carriers more frequently developed SWI than non-carriers, respectively, 11% vs. 5.5% (P<0.05). Because of the small sample, MDRGNB carriers could not be analyzed. For prediction of MSSA SWI with preoperative MSSA carriage, the area under the receiver operating characteristic (ROC) curve was 0.720 (95% confidence interval (CI), 0.364-0.796) and 0.710 (95% CI, 0.623-0.787) for prediction of MRSA SWI with preoperative MRSA carriage. Preoperative MSSA carriage is frequent but preoperative MRSA or MDRGNB carriage remains infrequent. The ability of preoperative carriage to predict a same-pathogen-postoperative SWI was low and should not be used to guide empirical antibiotherapy.

Implications of Methicillin-Resistant Staphylococcus aureus Carriage on Cardiac Surgical Outcomes

“…In addition, there were no differences in mediastinitis or even SSIs. In agreement with our finding, Maillet and colleagues 11 suggested that MRSA colonization was a poor predictor of sternal wound infection. Of 128 patients who had SSIs, only 4 were MRSA carriers.…”

“…10 Current single-center studies are limited by low MRSA prevalence, or, conversely, they overestimate MRSA carriage where it is endemic. 4,7,11 A broad-picture view of MRSA carrier prevalence nationwide in cardiac surgery and the outcomes in these patients is needed.…”

Analysis of Risk Factors for Multiantibiotic-Resistant Infections Among Surgical Patients at a Children's Hospital

“…In addition, when a preoperative infection causes low immunity at admission, colonized pathogen carriers more frequently develop multiantibiotic-resistant infections, a finding that is in agreement with previous reports. 38…”

Cardiopulmonary exercise testing screening and pre‐operative pulmonary rehabilitation reduce postoperative complications and improve fast‐track recovery after lung cancer surgery: A study for 342 cases

“… 25 Testing the pre-operative prediction of pathogens, which may be involved in airway infection, could guide antibiotics. 26 Of course, the emergence of antimicrobial resistance has been contemporaneous with the intensive use of antibiotics. 27 Therefore, pre-operative antimicrobial therapy is not routinely recommended in all patients with high risks, but only in heavy smokers and patients of advanced age.…”