The endogenous pathway is a major route for deep sternal wound infection

Jakob, Heinz; Borneff-Lipp, M.; Bach, Alfons; Pückler, Stefanie von; Windeler, Jürgen; Sonntag, Hans‐Günther; Hagl, S.

doi:10.1016/s1010-7940(00)00327-4

Cited by 113 publications

(69 citation statements)

References 23 publications

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“…Most of nosocomial infections occurred after clean contaminated and contaminated procedures. This finding is also consistent with prevention reports (Horan et al, 1993;Jacob et al, 2000). The infection rate in the ward was 43.1% while the theatre was 41.9%, the difference was statistically significant.…”

Section: Discussionsupporting

confidence: 92%

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Niemogha¹,

Atoyebi²,

Ogunsola³

et al. 2011

Sierra Leone j. biomed. res.

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Surgical procedures often lead to both intrinsic and extrinsic infections. In order to improve on recovery of patients, investigations were carried out on samples collected from patients during and after surgery. Laboratory analysis was performed on wound swabs from incision, colon segments, scrapes, tissues, pus and catheter specimen urine. The samples were cultured on MacConkey and Blood agar and incubated aerobically at 37 0 C for 16-24 hours. Thereafter, isolates were identified using standard microbiological methods. Results showed that isolates from wound were also found on endogenous indicators of surgery. Klebsiella species from incision was 15 (18.75%) while those from colon segment was 30(37.6%), scrapes 8(16%) and pus 3(7.5%). Acinetobacter species found on incision was 15(7.5%) and pus 7(2.3%). Pseudomonas species was distributed on incision 5(2.5%), colon segment 4(5%), tissue 3(1.6%), scrapes 5(10%) and pus was 5(12.5%). Staphylococcus aureus which was isolated from incision was 2(1%), while scrapes and pus were 5(10%) and 7(17.5%) respectively. Catheter associated urinary tract infections yielded significant bacteriuria (64.7%), almost twice the rate of non-significant bacteriuria (35.3%); indicating the need to remove all catheters as soon as possible. Antibiogram of isolates of Klebsiella pneumoniae with resistance pattern: ApGnNaNt, Escherichia coli (ApCtNaTtCm) and S. aureus (ApChCxErPn) with plasmid sizes in the range (30.2-52.51Kb) were common to both indicators and wound, showing that the pathogens were the same clusters. This study demonstrated surgical procedures as precursory to intrinsic infections and that bacterial pathogens found on wounds and endogenous indicators of surgery are links to intrinsic infection. The study therefore emphasizes the need to culture wounds promptly to effect speedy recovery of patients who have undergone surgery.

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Section: Discussionsupporting

confidence: 92%

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Niemogha¹,

Atoyebi²,

Ogunsola³

et al. 2011

Sierra Leone j. biomed. res.

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“…It has been recommended for the preoperative eradication of S. aureus from patients undergoing cardiac surgery, 6 patients with human immunodeficiency virus, 7 and patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis. 18 However, considerable controversy exists as to whether attempts to control the asymptomatic carriage of S. aureus are productive.…”

mentioning

confidence: 99%

Nasal Carriage of Methicillin- Susceptible and Methicillin-ResistantStaphylococcus aureusAmong Paramedics in the Sedgwick County Emergency Medical Service in Wichita, Kansas

Elliott

Kellum²,

Tenover³

et al. 2002

Infect. Control Hosp. Epidemiol.

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“…Jakob, et al carried out nasal cultures for 376 adult heart surgery patients, and used deoxyribonucleic acid (DNA) fingerprint analysis to distinguish whether deep sternal wound infections were caused by endogenous or exogenous pathways. 22) DNA fingerprint analysis also showed that the DNA patterns of S. aureus from the nasal cavity and sternum were identical, demonstrating that the endogenous infection pathway is the major route for deep sternal wound infection. They therefore insisted that the preoperative eradication of locally colonized S. aureus is important in terms of preventing serious SSIs and mediastinitis.…”

Section: Discussionmentioning

confidence: 89%

“…This clinical study was approved by the Ethics Committee of our hospital (screening number: [21][22][23][24][25]. The National Nosocomial Surveillance System (NNIS) definitions were used to classify SSI as superficial wound infections, deep incisional infections, or organ space infections (Mediastinitis).…”

Section: Methodsmentioning

confidence: 99%

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

Katayanagi

2015

ATCS

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Background: Mediastinitis caused by methicillin-resistant Staphylococcus aureus (MRSA)is a serious complication after pediatric cardiac surgery. An outbreak of surgical site infections (SSIs) provided the motivation to implement SSI prevention measures in our institution. Methods: Subjects comprised 174 pediatric patients who underwent open-heart surgery after undergoing preoperative nasal culture screening. The incidence of SSIs and mediastinitis was compared between an early group, who underwent surgery before SSI measures (Group E, n = 73), and a recent group, who underwent surgery after these measures (Group R, n = 101), and factors contributing to the occurrence of mediastinitis were investigated. Results: The incidence of both SSIs and Mediastinitis has significantly decreased after SSI measures. With regard to factors that significantly affected mediastinitis, preoperative factors were "duration of preoperative hospitalization" and "preoperative MRSA colonization," intraoperative factors were "Aristotle basic complexity score," "operation time," "cardiopulmonary bypass circuit volume" and "lowest rectal temperature." And postoperative factor was "blood transfusion volume." Patients whose preoperative nasal cultures were MRSA-positive suggested higher risk of MRSA mediastinitis. Conclusions: SSI prevention measures significantly reduced the occurrence of SSIs and mediastinitis. Preoperative MRSA colonization should be a serious risk factor for mediastinitis following pediatric cardiac surgeries.

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The endogenous pathway is a major route for deep sternal wound infection

Abstract: The determination of the endogenous pathway for severe wound infection makes prevention possible by means of preoperative local S. aureus eradication.

Cited by 113 publications

References 23 publications

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Nasal Carriage of Methicillin- Susceptible and Methicillin-ResistantStaphylococcus aureusAmong Paramedics in the Sedgwick County Emergency Medical Service in Wichita, Kansas

Nasal Methicillin-Resistant S. Aureus is a Major Risk for Mediastinitis in Pediatric Cardiac Surgery

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