Interventions to prevent surgical site infection in adults undergoing cardiac surgery

Rogers, Luke; Vaja, Ricky; Bleetman, David; Ali, Jason M.; Rochon, Melissa; Sanders, Julie; Tanner, Judith; Lamagni, Theresa; Talukder, Shagorika; Quijano‐Campos, Juan Carlos; Lai, Florence; Loubani, Mahmoud; Murphy, Gavin J.

doi:10.1002/14651858.cd013332

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…With an aggressive preventive approach, some centers report zero incidence of sternal infection. 14,22 However, there is no evidence-based preventive “bundle.” 7,23-25 Strong evidence supports the perioperative administration of antibiotics, 9,26 with general agreement that continuation of prophylactic antibiotics for >48 hours lacks additional benefit. Mupirocin has been found to be effective in reducing Staphylococcus aureus infection in patients who are nasal carriers, and there is no evidence that it is beneficial for those who are not.…”

Section: Pharmacotherapy In Patients Undergoing Cabgmentioning

confidence: 99%

“…16 However, the associated risk of death may increase several-fold, 17 while the associated morbidity and expense can be considerable. 7 Management of hyperglycemia with perioperative insulin infusion to maintain a glucose level <180 mg/dL, both in patients with known diabetes and in patients with stress hyperglycemia, has emerged as an important strategy to prevent infection, as well as to improve survival and reduce recurrent ischemic events. 1-3,18,19 Continuous intravenous insulin infusion after CABG reduces postoperative complications, such as mediastinitis, cardiac arrhythmias, deep sternal would infections, renal failure, and length of stay.…”

Section: Pharmacotherapy In Patients Undergoing Cabgmentioning

confidence: 99%

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2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

et al. 2022

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Aim: The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. Methods: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients’ interests.

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Section: Pharmacotherapy In Patients Undergoing Cabgmentioning

confidence: 99%

Section: Pharmacotherapy In Patients Undergoing Cabgmentioning

confidence: 99%

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

et al. 2022

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“…Trust level responses to questions on perioperative SSI prevention practices are listed in Table I. Centres reported which aspects of the DH/National UK High Impact Intervention bundle (2010/2011) [10] were routinely performed; of these screening for methicillin resistant S. aureus (MRSA) colonisation and hair removal with electric clippers were performed by all 19 centres (Table I). Preoperative showering and glucose control for diabetic patients was routinely performed in 18 centres (95%).…”

Section: Hospital Trust Surveymentioning

confidence: 99%

“…The certainty of evidence to support these interventions is low which may explain the poor uptake found in our survey. Although increasing compliance to these interventions may reduce SSI, there is a risk of increasing antimicrobial resistance which is an emerging risk to global health and is the subject of a five-year action plan (2019-2024) in the UK [10]. Therefore a balance between a maximum reduction in SSI and minimal antimicrobial resistance is needed.…”

Section: Clinical Importancementioning

confidence: 99%

National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland

Aktuerk

Ali²,

Badran³

et al. 2020

Journal of Hospital Infection

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Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland

Ackah

Neal

Marshall

et al. 2020

Journal of Infection Prevention

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Background: Deep sternal wound infections are a financially costly complication of cardiac surgery with serious implications for patient morbidity and mortality. Prophylactic antimicrobials have been shown to reduce the incidence of infection significantly. In 2018, the European Association for CardioThoracic Surgery (EACTS) provided clear guidance advising that third-generation cephalosporins are the first-line prophylactic antimicrobial of choice for cardiac surgery via median sternotomy as a result of their broad spectrum of activity and association with reduced postoperative mortality. Despite this guidance, it was believed that UK practice differed from this as a consequence of national concerns surrounding cephalosporins use and Clostridioides difficile infection. Methods: A survey was developed and distributed to all UK and Republic of Ireland (ROI) cardiac surgery centres in January 2019 to quantify this variation. Results: Of the 38 centres, 34 responded. Variation existed between the antimicrobial agent used, as well as the dosage, frequency and duration of suggested regimens even among centres using the same antimicrobial agent. The most common antimicrobial prophylaxis prescribed was a combination of flucloxacillin and gentamicin (16, 47%). Followed by cefuroxime (6, 17.6%) and cefuroxime combined with a glycopeptide (4, 11.7%). In patients colonised with methicillin-resistant Staphylococcus aureus or those with penicillin allergy gentamicin combined with teicoplanin was most common (42% and 50%, respectively). Discussion: This variation in antimicrobial agents and regimens may well contribute to the varying incidence of surgical site infection seen across the UK and ROI.

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Interventions to prevent surgical site infection in adults undergoing cardiac surgery

Cited by 3 publications

References 15 publications

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

National survey of variations in practice in the prevention of surgical site infections in adult cardiac surgery, United Kingdom and Republic of Ireland

Antimicrobial prophylaxis in adult cardiac surgery in the United Kingdom and Republic of Ireland

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