Surgical site infection in patients submitted to heart transplantation

Rodrigues, Jussara Aparecida Souza do Nascimento; Ferretti-Rebustini, Renata Eloah de Lucena; Poveda, Vanessa de Brito

doi:10.1590/1518-8345.0821.2700

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Surgical management formed the basis of the treatment of surgical site and abdominal infections. The rates of these sources, rate of mortality, and the proportion of cases managed conservatively was similar to those described previously [23,[40][41][42][43]. No differences were found comparing the mortality of patients treated with a surgical approach to those managed conservatively, although the small sample size and the subjective indication of surgery limits the interpretation of these results.…”

Section: Discussionsupporting

confidence: 83%

In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

Gómez-López

Barge‐Caballero

Fernández-Ugidos

et al. 2020

Surgical Infections

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Background: Infection is a major cause of morbidity and mortality after heart transplantation (HT). Little information about its importance in the immediate post-operative period is available.The aim of this study was to analyze the characteristics, incidence, and outcomes of in-hospital post-operative infections after HT. Methods: We conducted an observational, single-center study based on 677 adults who underwent HT from 1991 to 2015 and who survived the surgical intervention. In-hospital post-operative infections were identified retrospectively according to the medical finding in the clinical records.Results: Over a mean hospital stay of 24.5 days, 239 patients (35.3%) developed 348 episodes of infection (2 episodes per 100 patient-days). The most common sources of infection were those related to invasive procedures (respiratory infections, 115 [33%]; urinary tract infections, 47 [13.5%]; bacteremia, 42 [12.1%]; surgical site infections, 25 [7.2%]), in addition to abdominal focus (33, 9.5%). Enterobacteriaceae (76, 21.8%) and gram-positive cocci (58, 16.7%) were the predominant germs, although opportunistic infections were not infrequent (69, 19.8%). Ninetyfive septic episodes were detected with a mean Sequential Organ Failure Assessment Score of 9.5 -5.3 points, with hemodynamic failure being the most severe organ dysfunction and renal dysfunction the most frequent one. Management included broad-spectrum antibiotics in 48.8% of episodes and surgical management in 13.8%. The overall antimicrobial success rate was 96.3%.Higher in-hospital mortality was observed among infected patients (15.1% vs. 10.3%), but this difference was not statistically significant (p = 0.067). The one-year survival and events were not different between patients suffering from a post-operative infection and those who did not. Conclusions:In-hospital infections were frequent in the post-operative period after HT and were associated with a poor short-term outcome. Patients who survived sepsis had a similar one-year morbidity and mortality compared with patients who did not develop an infection.

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Section: Discussionsupporting

confidence: 83%

In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

Gómez-López

Barge‐Caballero

Fernández-Ugidos

et al. 2020

Surgical Infections

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“…[ 30 – 32 ] In our study, the results showed no association between preoperative skin preparation and SSI. It is similar to the Poveda and coworkers’ [ 33 ] study showing no association between shaving and SSI. We also found that there was no significant difference in SSI rate or sign of infection between hair shaving and 2% chlorhexidine groups.…”

Section: Discussionsupporting

confidence: 91%

Randomized clinical trial of preoperative skin preparation with 2% chlorhexidine versus conventional hair shaving in percutaneous coronary intervention

et al. 2021

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Background: Preoperative skin preparation is associated with surgical site infection (SSI). Traditional preoperative shaving fails to reduce the risk of SSI. The efficacy of 2% chlorhexidine for preoperative skin preparation in percutaneous coronary intervention (PCI) is sketchy. The aim of this trial was to evaluate whether preoperative skin preparation performed with chlorhexidine was not inferior to a conventional hair removal method. Methods: Seventy-eight patients undergoing PCI were randomized into 2 groups of 39 patients, receiving either single sterilization with 2% chlorhexidine or hair shaving respectively between July 2016 and October 2016. The primary endpoints were wound infection rate and bacterial counts. Secondary endpoints were rate of SSI and adverse effects of 2% chlorhexidine. Results: The results showed that 2% chlorhexidine significantly reduced the colonization of Staphylococcus aureus ( P = .032), S epidermidis ( P = .000), and miscellaneous bacteria ( P = .244) in comparison with hair shaving, respectively. Redness in 24 hours after surgery was observed in 6 patients in the control group (15.4%) and 5 patients (12.8%) in 2% chlorhexidine group. There was no statistically significant difference in SSI rate between 2 skin preparations. Conclusion: In PCI, preoperative skin preparation with 2% chlorhexidine was not inferior to conventional hair shaving in terms of the wound infection rate and SSI rate.

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“…Following MHS, infection risk estimates are often biased as different reports usually consider only certain factors such as a given period of postoperative stay, type of surgery, type of infection or even certain groups of causative microorganisms. For instance, the reported incidence of surgical wound infection ranges from 2.6 to 5.5% and is higher in heart transplant recipients [ 5 , 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Infectious complications following major heart surgery from the day of the surgery to hospital discharge

Pérez-Granda,

Barrio,

Cuerpo

et al. 2024

BMC Infect Dis

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Background At some point in their lives, many people will require major heart surgery (MHS). Patients are generally older adults with various risk factors for infection. However, the incidence of infection after MHS is poorly known, as reported infection data are frequently biased due to different factors like the surgical procedure, postoperative timing, and infectious syndromes or etiologic agents, among others. In addition, most patient data are retrospectively obtained. Purpose and methods Data were prospectively collected regarding the incidence of all nosocomial infections produced from the time of surgery to hospital discharge in a cohort of 800 adults consecutively undergoing a MHS procedure. Results During postoperative hospitalization, 124 of the 800 participants developed one or more infections (15.5%): during their ICU stay in 68 patients (54.8%), during their stay on the general ward post ICU in 50 (40.3%), and during their stay in both wards in 6 (4.8%). The most common infections were pneumonia (related or not to mechanical ventilation), surgical site and bloodstream. As etiological agents, 193 pathogens were isolated: mostly Gram-negative bacilli (54.4%), followed by Gram-positive bacteria (30%), viruses (4.6%) and fungi (1.5%). In our cohort, all-cause mortality was recorded in 33 participants (4.1%) and 9 infection-related deaths (1.1%) were produced. Among subjects who developed infections, overall mortality was 13.7% and in those who did not, this was only 2.3%. Conclusion Infection following MHS remains frequent and severe. Our data suggest that hospital-acquired infection studies should consider episodes of infection in all populations during their entire hospital stay and not only those related to specific clinical syndromes or acquired while the patient is in intensive care.

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Surgical site infection in patients submitted to heart transplantation

Cited by 6 publications

References 17 publications

In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome

Randomized clinical trial of preoperative skin preparation with 2% chlorhexidine versus conventional hair shaving in percutaneous coronary intervention

Infectious complications following major heart surgery from the day of the surgery to hospital discharge

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