Mediastinitis After Coronary Artery Bypass Graft Surgery

Milano, Carmelo A.; Kesler, Karen; Archibald, N; Sexton, Daniel J.; Jones, Robert H.

doi:10.1161/01.cir.92.8.2245

Cited by 328 publications

(243 citation statements)

References 14 publications

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“…Milano et al [14] discussed some factors that could explain why obesity is a risk factor. The dose of prophylactic antibiotics not corrected for body mass index of the patient, for example.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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Section: Discussionmentioning

confidence: 99%

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Sá¹,

Soares²,

Santos³

et al. 2011

Rev Bras Cir Cardiovasc

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“…[2][3][4] Among the different approaches to prevent these infections, antimicrobial prophylaxis is of substantial importance. Despite evidence from randomized clinical trials and other data supporting antibiotic prophylaxis (ABP) for no longer than 48 hours, [5][6][7][8] controversy persists about the optimal duration of prophylaxis.…”

mentioning

confidence: 99%

Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance

et al. 2000

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Background-Despite evidence supporting short antibiotic prophylaxis (ABP), it is still common practice to continue ABP for more than 48 hours after coronary artery bypass graft (CABG) surgery. Methods and Results-To compare the effect of short (Ͻ48 hours) versus prolonged (Ͼ48 hours) ABP on surgical site infections (SSIs) and acquired antimicrobial resistance, we conducted an observational 4-year cohort study at a tertiary-care center. An experienced infection control nurse performed prospective surveillance of 2641 patients undergoing CABG surgery. The main exposure was the duration of ABP, and main outcomes were the adjusted rate of SSI and the isolation of cephalosporin-resistant enterobacteriaceae and vancomycin-resistant enterococci (acquired antibiotic resistance). Adjustment for confounding was performed by multivariable modeling. A total of 231 SSIs (8.7%) occurred after a median of 16 days, including 93 chest-wound infections (3.5%) and 13 deep-organ-space infections (0.5%). After 1502 procedures using short ABP, 131 SSIs were recorded, compared with 100 SSIs after 1139 operations with prolonged ABP (crude OR, 1.0; CI, 0.8 to 1.3). After adjustment for possible confounding, prolonged ABP was not associated with a decreased risk of SSI (adjusted OR, 1.2; CI, 0.8 to 1.6) and was correlated with an increased risk of acquired antibiotic resistance (adjusted OR, 1.6; CI, 1.1 to 2.6). Conclusions-Our findings confirm that continuing ABP beyond 48 hours after CABG surgery is still widespread; however, this practice is ineffective in reducing SSI, increases antimicrobial resistance, and should therefore be avoided.

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“…However, mortality and morbidity rates during treatment are high [1,6,7]. Much has been done to identify and treat its risk factors, which are multiple and, when two or more factors occur concomitantly, its action seems to be enhanced [4, 5,8].…”

Section: Discussionmentioning

confidence: 99%

“…Reconstruction performed with the use of flaps, which aims at filling anterior mediastinal dead space and an increase in blood supply, has shown low mortality rates. Nevertheless, disadvantages associated with this method include an increase in surgical trauma, persistent pain in the flap, muscle weakness, and hernias [7]. Moreover, there are several series exhibiting poor long-term results with these techniques.…”

Section: Revmentioning

confidence: 99%

“…However, mortality associated with such surgical complications, even after appropriate treatment, is extremely high, ranging between 14% and 47% [1,6,7]. Several studies have identified risk factors such as obesity, diabetes, reoperation, smoking, prolonged operative time, bilateral use of the internal thoracic artery, and postoperative bleeding [4,5,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound

Gib¹,

Alvarez²,

Wender³

2013

Revista Brasileira De Cirurgia Cardiovascular

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200Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):200- INTRODUCTIONMedian sternotomy is the technical approach most used in the surgical treatment of cardiopathies. Mediastinitis is a severe complication leading to an increase in hospital costs, morbidity and mortality [1,2]. The treatment, however, has progressed with new antibiotics, along with technical and surgical care.Postoperative incidence of mediastinitis ranges from 0.5% to 5% [3][4][5]. However, mortality associated with such surgical complications, even after appropriate treatment, is extremely high, ranging between 14% and 47% [1,6,7]. Several studies have identified risk factors such as obesity, diabetes, reoperation, smoking, prolonged operative time, bilateral use of the internal thoracic artery, and postoperative bleeding [4,5,8,9].Surgical management of postoperative mediastinitis counts on several techniques described in the literature [5,[10][11][12][13][14][15][16][17]. Treatment may include single-or multiple-stage procedures, with or without the use of muscle or omental flap [11,12,18]. Therapeutic modalities encompass two options: preconditioning of the wound, leaving the wound open for a better cleaning and mediastinal drainage with dressings, or using one of the several closure techniques available. Singlestage closure shows a recurrence rate between 5%-50% in comparison to two-stage closure whose rate ranges from 2%-30% [19,20], however the long term exposure of the mediastinum enhances the morbidity.The present study aims to compare inpatient mortality rate from surgical debridement followed by primary wound closure with that from surgical debridement with closure after preconditioning of the wound. METHODSFrom January 2000 to December 2008, at Hospital de Clínicas de Porto Alegre (HCPA), southern Brazil, 3,166 cardiac surgeries were performed in adults using median sternotomy and extracorporeal circulation (ECC). A historical cohort of patients who had postoperative mediastinitis was followed up during hospital stay after the first surgery and reintervention(s). From 2007, we implemented the protocol of preconditioning of the wound for all patients. Data were abstracted from the patient's medical records. The entire patient sample that showed mediastinitis during this period was identified through the Cardiovascular Surgery Division records in combination with those from the Commission on Hospital Infection Control (CCIH) of HCPA. Mediastinitis was defined as deep surgical wound infection with clinical and microbiologic evidence of compromised retrosternal space. During this period, 49 patients developed mediastinitis, an incidence of 1.55%. Of these, 43 patients met the classification criteria (El Oakley) [3] as type III or IV and were included in the study.The diagnosis of mediastinitis was based on physical examination and laboratory tests. Three diagnostic criteria were elected during initial evaluation: sternal instability; leukocytosis of more than 15,000; and wound secretion. All patients w...

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Mediastinitis After Coronary Artery Bypass Graft Surgery

Cited by 328 publications

References 14 publications

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Risk factors for mediastinitis after coronary artery bypass grafting surgery

Prolonged Antibiotic Prophylaxis After Cardiovascular Surgery and Its Effect on Surgical Site Infections and Antimicrobial Resistance

Mediastinitis: mortality rate comparing single-stage surgical approach and preconditioning of wound

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