Methicillin-Resistant <b><i>Staphylococcus aureus </i></b>Infection: An Independent Risk Factor for Mortality in Patients with Poststernotomy Mediastinitis

Abstract

Objective: The mortality rate of patients with poststernotomy mediastinitis remains very high. The aim of this study was to identify the risk factors associated with mortality in these patients. Subjects and Methods: Surveillance of sternal surgical-site infections including mediastinitis was carried out for adult patients undergoing a sternotomy between 2004 and 2012. Criteria from the US Centers for Disease Control and Prevention were used to make the diagnosis. All data on patients with a diagnosis of mediastinitis who were included in the study and on mortality risk factors were obtained from the hospital database and then analyzed using SPPS 16.0 for Windows. Results: Of the 19,767 patients undergoing open heart surgery, 117 (0.39%) had poststernotomy mediastinitis; 32% of these 117 died. The independent risk factors for mortality were methicillin-resistant Staphylococcus aureus (MRSA) [odds ratio (OR) 12.11 and 95% confidence interval (CI) 3.15-46.47], intensive-care unit stays >48 h after the first operation (OR 11.21 and 95% CI 3.24-38.84) and surgery that included valve replacement (OR 6.2 and 95% CI 1.44-27.13). The mortality rate decreased significantly, dropping from 38% (34/89) between 2004 and 2008 to 14% (4/28) between 2009 and 2012 (p = 0.018). Conclusion: In this study, elimination of MRSA from the hospital setting decreased the rate of mortality in patients with poststernotomy mediastinitis.

Invited Commentary on the Paper Entitled ‘Methicillin-Resistant <b><i>Staphylococcus aureus</i></b> Infection: An Independent Risk Factor for Mortality in Patients with Poststernotomy Mediastinitis'

“…Even if the mortality is very high, the only adequate antibiotic therapy seems insufficient, as survival data showed. This study also supports the finding that delayed appropriate antibiotic therapy will result in a statistically significant increase in mortality [ 1 ].…”

“…Yavuz et al [ 1 ] investigated independent risk factors in patients suffering from PSM. The study clearly showed that improvement of infection control interventions can dramatically decrease SSI rates.…”