Sternal wound infections following cardiac surgery and their management: a single-centre study from the years 2016–2017

Abstract

IntroductionDespite improvements in surgical management, sternal wound infection (SWI) following cardiac surgery remains a significant complication.AimTo evaluate pathogens involved in SWI following median sternotomy.Material and methodsWe enrolled 164 patients who experienced prolonged sternal wound healing following open-heart surgery. The inclusion criteria were as follows: prolonged sternal wound healing following cardiac surgery via median sternotomy and complete results of microbiological culture obtained from the sternal swab. The exclusion criteria were as follows: partial sternotomy, patients with mechanical sternum dehiscence and incomplete clinical data. Swabs provided information on the type of microorganism present in the wound and the susceptibility of the microorganism to specific antibiotics.ResultsOne hundred and fourteen (69.5%) patients aged 68 (interquartile range: 60–76) years developed SWI with positive culture. The in-hospital mortality rate was 21.0% in this group. The most common pathogens included Staphylococcus epidermidis (26.6%), Enterococcus faecium (12.2%), Staphylococcus aureus (11.4%), Klebsiella pneumoniae (8.4%), and Pseudomonas aeruginosa (6.8%). In most of the cases the isolated Staphylococcus epidermidis was methicillin-resistant (n = 57, 43.5%). Enterococcus faecium was vancomycin-resistant in 11 (8.3%) cases and high-level aminoglycoside resistant (HLAR) in 13 (9.9%) cases. Klebsiella pneumoniae had the extended-spectrum β-lactamase (ESBL) mechanism in 14 (10.6%) cases. Among 114 culture-positive patients, 48 (42.1%) had polymicrobial infection of the sternal wound.ConclusionsMicroorganisms associated with SWI in our study were mainly commensals, with the most common pathogen being Staphylococcus epidermidis.

The influence of obesity on in-hospital clinical outcomes after recanalisation of chronic total occlusions

“…Firstly, successful procedures and complications in the hospital proved to be independent of BMI categories. This finding seems quite remarkable, given that we are already aware of overweight and obese patients from Western countries having a higher likelihood of getting In-hospital outcomes a wound infection following CABG [12]. This suggests that CTO-PCIs might be a safer alternative to CABG in very obese patients.…”

Infections due to multidrug‐resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes

“…However, routine surveillance for VRE and MRSA is not performed at our institution, and any colonization would have been identified on clinical specimens. While there are no data specific to HT, in one recent study of sternal wound infections following cardiac surgery, 12% of cases were due to VRE . These data support that the emergence of VRE is not confined to abdominal transplantation, and that these infections can be commonly seen among HT recipients; especially those with post‐transplant complications requiring prolonged hospital stay and broad‐spectrum antibiotics.…”

Kardiyak cerrahi sonrası gelişen sağlık bakımı ile ilişkili enfeksiyonların değerlendirilmesi-tek merkez deneyimi

“…Bunların %78,6 (11)'sında CAE gelişti ve yine bu hasta grubunda literatürdeki çalışmaların aksine etyolojide gram negatif mikroorganizmaların predominansı (%57,1) saptandı. Güncel çalışmalarda kardiyak cerrahi sonrası CAE'larında gram negatif bakterilerin %21,7-35 oranında etken olduğu bildirilmiş iken çalışmamızı destekleyen veri ülkemizde yapılmış yayınlardan Taş ve arkadaşlarının yaptığı bir çalışma sonuçlarından gelmiştir [25][26][27] .Nitekim bu çalışmada preoperatif ve postoperatif dönemde iyi regüle edilmeyen kan glukoz düzeylerinin yara yeri enfeksiyonu açısından önemli bir risk faktörü olduğu vurgulanmış ve çalışmamızda da olduğu gibi diyabetik hastalarda yara yeri enfeksiyonunda gram negatif mikroorganizmaların önde gelen etken olduğu saptanmıştır 27…”