Emerging trends in mediastinitis: National Veterans Health Administration experience with methicillin-resistant Staphylococcus aureus prevention

Wojnarski, Charles M.; Elgudin, Yakov; Rubelowsky, Joseph; Wilson, Brigid; Donskey, Curtis J.; Cmolik, Brian

doi:10.1016/j.jtcvs.2020.02.116

Cited by 11 publications

(17 citation statements)

References 16 publications

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“…Gram-positive bacteria have long been considered the commonest microorganisms (89%) in surgical site infections following cardiac surgery, while Gram-negative bacteria are the causative agents only in 10% of cases [ 9 ]; however, recent findings give evidence of changes in microbiology with an increased role of Gram-negative bacteria (24.5% of cases) and a relative lower role of Gram-positive bacteria (75.5% of cases) [ 66 ].…”

Section: Risk Factorsmentioning

confidence: 99%

Nosocomial Extracardiac Infections After Cardiac Surgery

Zardi

Chello

Zardi³

et al. 2022

Curr Infect Dis Rep

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Purpose of Review Nosocomial extracardiac infections after cardiac surgery are a major public health issue affecting 3–8.2% of patients within 30–60 days following the intervention. Recent Findings Here, we have considered the most important postoperative infective complications that, in order of frequency, are pneumonia, surgical site infection, urinary tract infection, and bloodstream infection. The overall picture that emerges shows that they cause a greater perioperative morbidity and mortality with a longer hospitalization time and excess costs. Preventive interventions and corrective measures, diminishing the burden of nosocomial extracardiac infections, may reduce the global costs. A multidisciplinary team may assure a more appropriate management of nosocomial extracardiac infections leading to a reduction of hospitalization time and mortality rate. Summary The main and most current data on epidemiology, prevention, microbiology, diagnosis, and management for each one of the most important postoperative infective complications are reported. The establishment of an antimicrobial stewardship in each hospital seems to be, at the moment, the more valid strategy to counteract the challenging problems.

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Section: Risk Factorsmentioning

confidence: 99%

Nosocomial Extracardiac Infections After Cardiac Surgery

Zardi

Chello

Zardi³

et al. 2022

Curr Infect Dis Rep

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“…According to recent data, the incidence of post-sternotomy mediastinitis is 1–5%, with a rate >2% being an indicator of poor quality care in the surgery centre [ 14 , 26 ]. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem, as they are associated with an increased length of hospital stay, substantial medical costs and high mortality ranging from 3% to 20% [ 7 , 21 , 27 , 28 , 29 , 30 ] and can reach up to 50% [ 13 , 28 , 31 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…A number of studies describe the aetiology of SSI after cardiac surgery. Most authors agree that almost two-thirds of the microorganisms isolated from infected patients are Gram-positive bacteria (60–80%), including S. aureus , coagulase-negative Staphylococcus and, in fewer cases, Propionibacterium acnes (currently: Cutibacterium acnes ) [ 13 , 26 , 27 , 63 ]. Staphylococci are the main bacteria responsible for postoperative SSIs, even though the reported number of SSI cases caused by this pathogen varies.…”

Section: Aetiologymentioning

confidence: 99%

Surgical Site Infection in Cardiac Surgery

Żukowska¹,

Żukowski

2022

JCM

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Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy

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“…Coronary artery bypass grafting (CABG), rather than percutaneous intervention, is the procedure of choice among diabetic patients with multi-vessel disease [1]. Mediastinitis and post-operative wound infection remains a concern among diabetes mellitus (DM) patients after cardiac surgery [2]. The Society of Thoracic Surgeons guidelines recommend that postoperative blood sugar should be maintained < 180 mg% for 72 hours [3].…”

Section: Introductionmentioning

confidence: 99%

“…How does the preoperative glycated hemoglobin (HbA1C) levels, a marker of glycemic control over a period of 90 days, in uence our ability to achieve optimal postoperative glycemic control (de ned as average blood sugar < 180 mg/dl after surgery)? (2) What is the composite impact of preoperative HbA1c and post-operative blood sugar control (de ned as BSL < 180 mg/dl) on infection during the early post-operative period?…”

Section: Introductionmentioning

confidence: 99%

The Association of Perioperative Glycemic control with Post-operative wound Infection after Coronary Artery Bypass Grafting in Veterans with Diabetes Mellitus

Elgudin

Deo

Rubelowsky

et al. 2021

Preprint

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Introduction: After coronary artery bypass (CABG), diabetes mellitus is associated with increased risk of infection. We model the inter-relationship of pre- and post-operative glycemic control and their composite influence on post-operative wound infection. Methods: 2,899 Veterans that underwent isolated CABG were stratified (Group I: < 8%, Group II: 8 - 10%, Group III: > 10%) according to preoperative HbA1c levels. We obtained the median blood sugar level (BSL) on post-operative days 0 - 4 (POD) and compared trends in BSL readings according to HbA1c groups. We fit a multi-variable random effects mixed model to understand the odds (OR) of developing postoperative mediastinitis. A two-stage joint model was fit to evaluate the adjusted hazard (HR) of pre-operative HbA1c, post-operative BSL and clinical factors on 90-day readmission for infection. Results: In groups I, II, and III had 66%, 25% and 9% patients respectively. In 148,810 post-operative BSL readings, median BSL values peaked at POD 2 (145 mg/dl). In group III, 29% BSL reading was above the recommended limit (< 180 mg/dl). Group III (OR 3.5; p < 0.01) and COPD (OR 2.51; p < 0.01) were associated with higher rates of mediastinitis. Groups II (HR 1.4; p = 0.01) and III (HR 1.5; p = 0.04) were associated with increased risk for 90-day readmission for infection. Post-operative blood sugar levels (p = 0.5) were not associated with increased risk for wound infection at 90 days. Conclusion: Among Veterans undergoing coronary artery bypass, a large proportion had HbA1c levels > 8%. In the post-operative period, 22% of the blood sugar readings are higher than 180 mg/dl. Preoperative HbA1c (rather than postoperative glycemic control) is associated with higher rates of deep sternal wound infection.

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Emerging trends in mediastinitis: National Veterans Health Administration experience with methicillin-resistant Staphylococcus aureus prevention

Cited by 11 publications

References 16 publications

Nosocomial Extracardiac Infections After Cardiac Surgery

Nosocomial Extracardiac Infections After Cardiac Surgery

Surgical Site Infection in Cardiac Surgery

The Association of Perioperative Glycemic control with Post-operative wound Infection after Coronary Artery Bypass Grafting in Veterans with Diabetes Mellitus

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