Effect of chlorhexidine skin disinfection and retrosternal gentamicin sponge on post-sternotomy mediastinitis: results from a prospective controlled registry of 2340 patients

Waldow, Thomas; Ghazy, Tamer; Madej, T.; Plötze, Katrin; Birkner, Christin; Mahlmann, Adrian; Matschke, Klaus

doi:10.1016/j.jhin.2018.01.016

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…4 Requirements for blood transfusion was also associated with an increased risk of poststernotomy mediastinitis. 34 Those receiving in excess of four units of red blood cells with or without the presence of preoperative anaemia were at higher risk of developing DSWI. 38 This was quantified in a further study that concluded that the risk of mild or severe SWI increased with the number of red blood cell transfusions required.…”

Section: Complicated Recoverymentioning

confidence: 96%

“…Out of the 25 papers reporting multivariant analysis, nineteen identified high body mass index as a key risk factor for an SSI 15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . Gender was highlighted in six papers, with female gender reported as a risk factor for developing SSI in five, with one reporting that female gender was associated with higher risk of sternal wound dehiscence 19 ; and the others reporting SSIs 4,22,35,27 .…”

Section: Demographic Factorsmentioning

confidence: 99%

“…The same paper identified patients with permanent or persistent atrial fibrillation were at higher risk of superficial sternal wound infection. 23 Peripheral vascular disease 32 and a history of stroke 34 were both identified as a risk factor for developing sternal complications, and patients with renal insufficiency presenting with a high serum creatinine >130μmol/L were at greater risk of both SSI in general 25 , and more specifically, mediastinal infections. 32…”

Section: Co-morbiditiesmentioning

confidence: 99%

“…Findings from a number of studies were conflicting, with CABG 26 , concomitant CABG and aortic valve replacement surgery 33 , and valve surgery 34 identified as being associated with significant risk of SSI. In addition, the risk of deep sternal wound infection was shown to increase with the number of valves affected by surgery 29 .…”

Section: Type Of Surgerymentioning

confidence: 99%

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Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature

et al. 2022

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Section: Complicated Recoverymentioning

confidence: 96%

Section: Demographic Factorsmentioning

confidence: 99%

Section: Co-morbiditiesmentioning

confidence: 99%

Section: Type Of Surgerymentioning

confidence: 99%

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Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature

et al. 2022

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Does routine topical antimicrobial administration prevent sternal wound infection after cardiac surgery?

Magro

Sousa-Uva

2020

Interactive CardioVascular and Thoracic Surgery

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Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether >238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and >23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.

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A review of the impact of food processing on antimicrobial-resistant bacteria in secondary processed meats and meat products

Hutchinson¹,

Corry²,

Madden³

2020

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For meat and meat products, secondary processes are those that relate to the downstream of the primary chilling of carcasses. Secondary processes include maturation chilling, deboning, portioning, mincing and other operations such as thermal processing (cooking) that create fresh meat, meat preparations and ready-to-eat meat products. This review systematically identified and summarised information relating to antimicrobial resistance (AMR) during the manufacture of secondary processed meatand meat products (SPMMP). Systematic searching of eight literature databases was undertaken and the resultantpapers were appraised for relevance to AMR and SPMMP. Consideration was made that the appraisal scores, undertaken by different reviewers, were consistent. Appraisal reduced the 11,000 initially identified documents to 74, which indicated that literature relating to AMR and SPMMP was not plentiful. A wide range of laboratory methods and breakpoint values (i.e. the concentration of antimicrobial used to assess sensitivity, tolerance or resistance) were used for the isolation of AMR bacteria.The identified papers provided evidence that AMR bacteria could be routinely isolated from SPMMP. There was no evidence that either confirmed or refuted that genetic materials capable of increasing AMR in non-AMR bacteria were present unprotected (i.e. outside of a cell or a capsid) in SPMMP. Statistical analyses were not straightforward because different authors used different laboratory methodologies.However, analyses using antibiotic organised into broadly-related groups indicated that Enterobacteriaceaeresistant to third generation cephalosporins might be an area of upcoming concern in SPMMP. The effective treatment of patients infected with Enterobacteriaceaeresistant to cephalosporins are a known clinical issue. No AMR associations with geography were observed and most of the publications identified tended to be from Europe and the far east.AMR Listeria monocytogenes and lactic acid bacteria could be tolerant to cleaning and disinfection in secondary processing environments. The basis of the tolerance could be genetic (e.g. efflux pumps) or environmental (e.g. biofilm growth). Persistent, plant resident, AMR L. monocytogenes were shown by one study to be the source of final product contamination. 4 AMR genes can be present in bacterial cultures used for the manufacture of fermented SPMMP. Furthermore, there was broad evidence that AMR loci could be transferred during meat fermentation, with refrigeration temperatures curtailing transfer rates. Given the potential for AMR transfer, it may be prudent to advise food business operators (FBOs) to use fermentation starter cultures that are AMR-free or not contained within easily mobilisable genetic elements. Thermal processing was seen to be the only secondary processing stage that served as a critical control point for numbers of AMR bacteria. There were significant linkages between some AMR genes in Salmonella. Quaternary ammonium compound (QAC) resistance genes were associated with copper, tetracycline and sulphonamide resistance by virtue of co-location on the same plasmid. No evidence was found that either supported or refuted that there was any association between AMR genes and genes that encoded an altered stress response or enhanced the survival of AMR bacteria exposed to harmful environmental conditions.

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Effect of chlorhexidine skin disinfection and retrosternal gentamicin sponge on post-sternotomy mediastinitis: results from a prospective controlled registry of 2340 patients

Cited by 3 publications

References 12 publications

Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature

Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature

Does routine topical antimicrobial administration prevent sternal wound infection after cardiac surgery?

A review of the impact of food processing on antimicrobial-resistant bacteria in secondary processed meats and meat products

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