Postoperative Wound Infections Following Cardiac Surgery: Significance of Contaminated Cases Performed in the Preceding 48 Hours

1984 ◽  
Vol 5 (8) ◽  
pp. 371-377 ◽  
Author(s):  
Malkanthie I. deSilva ◽  
J. Peter Rissing

AbstractPostoperative wound infections following open heart cardiac surgery increased markedly after hospital relocation (7 of 77 v; 4 of 320; p = .0007). Of the multiple identified risk factors, significant patient and procedural association included prolonged operative time of infected patients (384 minutes ± 115 SD v 318 ± 67, p = .025) and operation in a room used within the previous 48 hours for a contaminated case (4/7 infected v 10/67 not infected; p = .023). Several defects were discovered in the air handling system. After appropriate changes, the infection rate decreased in the next 12 months (1 of 109; p < .02). Other concurrent surgical wound infection rates remained unchanged suggesting that defective air handling may have impacted only on the open heart cardiac surgery patients. Preceding contaminated surgery and prolonged operative time were associated with postoperative wound infections in cardiac surgery.

Author(s):  
A. V. Stepin

Relevanc. Surgical Site Infection (SSI) after open heart surgery is a significant problem in clinical, social, and economic aspect which causes the need to identification of the preferred procedures for successful prevention of the SSI.Objectives. To determine risk of the SSI in cardiac surgery depending on complexity of intervention, using of cardiopulmonary bypass (CBP) and use of both internal mammary arteries (IMA).Methods. Prospective observations study from 2010 to 2019 in cardiac surgery department of the Ural Institute of Cardiology, where in total 4993 open heart surgery procedures were consecutively performed. All SSI cases were recorded up to 90 days after surgery. The analysis was performed to identify risk of cardiopulmonary bypass (CPB), bilateral IMA grafting and combined procedures on the risk of the postoperative wound infection.Results. During the investigation period, total 220 cases of the SSI (4,5%) have been registered of the 4993 patients undergoing open heart surgery. It included 42 cases of deep sternal infection (0,9%) and 178 cases of superficial infection (3,6%). The main pathogen identified was Staphylococcus epidermidis (56,4%). During the hospital period, 151 cases (66,5%) of SSI have been detected, with the median time to detection of the complication 6 days. The relative mortality risk in deep sternal infection group was 4,4 times higher than in the group without SSI (HR 4,6, 95 % CI 1,5-13,9, p=0,003624). CABG increases the relative risk of SSI in compare with non-CABG procedures (OR 3,086169; 95%CI 1,281 – 7,437), while the complexity of the operation (combined versus isolated interventions) does not significantly increase the risk (OR 0.972283; 95% CI: 0.696 - 1.359). The incidence of SSI in the group of in situ BIMA grafting was 8.8%, significantly increasing the likelihood of the SSI in compare to those with SIMA (OR 2.167983, 95% CI 1.463 - 3.212; p =0,000057). CBP significantly increases the risk of postoperative wound infections (OR 1.523890, 95% CI 1.149 - 2.022, p = 0.001742).Conclusions. Refusal of cardiopulmonary bypass, simultaneous procedures and bilateral coronary artery bypass does not allow completely to avoid postoperative wound infections. Nevertheless, the technical features of the preparations and use of grafts, including skeletonization, prevention of coagulation and the preference for sequential composite CABG, can reduce the risk associated with the type of the open heart surgery.


PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 235-237
Author(s):  
Donald A. Goldmann ◽  
Sylvia J. Breton

Streptococcus equisimilis (Lancefield group C), an unusual cause of nosocomial surgical infection, was isolated from two orthopedic postoperative wound infections. Both operations had been performed by the same surgeon within a three-day period. Examination of the surgeon revealed perianal dermatitis from which S. equisimilis was isolated. The organism was also recovered from the surgeon's nose and rectum. The wound infections responded to treatment with penicillin derivatives. The surgeon was successfully treated with topical bacitracin and oral penicillin and vancomycin. This report documents the pathogenicity of the C Streptococcus in postoperative infection and suggests a possible nosocomial source of the organism.


2014 ◽  
Vol 42 (5) ◽  
pp. 521-524 ◽  
Author(s):  
Cristina Díaz-Agero Pérez ◽  
Ana Robustillo Rodela ◽  
María José Pita López ◽  
Nieves López Fresneña ◽  
Vicente Monge Jodrá

1988 ◽  
Vol 17 (2) ◽  
pp. 60-64 ◽  
Author(s):  
PHILIP B. VASSEUR ◽  
JULIE LEVY ◽  
ELISA DOWD ◽  
JEFFREY ELIOT

1987 ◽  
Vol 8 (6) ◽  
pp. 249-254 ◽  
Author(s):  
Caryl Collier ◽  
Donald P Miller ◽  
Marguerite Borst

AbstractA one-year prospective study of surgeon-specific nosocomial infection rates was done in two community hospitals. Hospital A (93 beds) and Hospital B (158 beds) have nearly identical surgical staffs. Unified criteria for the diagnosis of infections, methods of data collection, and coding were used. Data were processed with an IBM 370 computer using Statistical Analysis System (SAS). Each surgeon received semiannual reports of 1) overall infection rate by site, 2) number of surgical wound infections by wound class and type of procedure, 3) pathogens for each deep and incisional infection, and 4) quarterly wound infection rates by wound class. Analysis of reports revealed high Class I surgical wound infection rates for both general and orthopedic surgeons. One person in each group had inordinately high infection rates. These data serve as an objective incentive to reduce surgical wound infections, identify individual problems, and suggest surgical privileges be evaluated by performance.


2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Sheema Gaffar ◽  
John K. Birknes ◽  
Kenji M. Cunnion

Fungal infections are rare causes of acute surgical wound infections, butCandidais not an infrequent etiology in chronic wound infections.Trichophytonspecies is a common cause of tinea capitis but has not been reported as a cause of neurosurgical wound infection. We report a case ofTrichophyton tonsuranscausing a nonhealing surgical wound infection in a 14-year-old male after hemicraniectomy. His wound infection was notable for production of purulent exudate from the wound and lack of clinical improvement despite empiric treatment with multiple broad-spectrum antibiotics targeting typical bacterial causes of wound infection. Multiple wound cultures consistently grewTrichophytonfungus, and his wound infection clinically improved rapidly after starting terbinafine and discontinuing antibiotics.


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