Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

Bouza, Emilio; Alarcón, Arı́stides de; Fariñas, María Carmen; Gálvez, Juan Francisco Pérez; Goenaga, Miguel Ángel; Gutiérrez-Díez, Francisco; Hortal, Javier; Lasso, José M.; Mestres, Carlos A.; Miró, José M.; Navas, Enrique; Nieto, M.; Parra, Antonio; Sota, Enrique Pérez de la; Rodríguez‐Abella, Hugo; Rodríguez‐Créixems, Marta; Rodríguez-Roda, Jorge; Espín, Gemma Sánchez; Sousa, Dolores; Sierra, Carlos; Muñóz, Patricia; Kestler, Martha

doi:10.3390/jcm10235566

Cited by 19 publications

(43 citation statements)

References 304 publications

(378 reference statements)

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“…O consumo de líquidos claros no período de 2 a 4 horas antes da anestesia geral tem se mostrado benéfico, impactando a diminuição das complicações pós-operatórias (38) . Pacientes que receberam bebidas líquidas ricas em carboidratos neste período apresentaram menores taxas de infecção e menor tempo de dependência de drogas vasoativas (39) .…”

Section: Discussionunclassified

Surgical site infection in adult patients after heart procedures: an integrative review

et al. 2022

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Objective: to identify the risk factors for surgical site infection in patients after heart procedure. Methods: integrative literature review by searching the Medical Literature Analyses and Retrieval System online, Latin American and Caribbean Literature on Health Sciences, Scientific Electronic Library Online, Nursing Database. The search for the articles occurred during the month of February 2022. Results: 24 articles were eligible for the review. In all studies, the population was mostly male, aged between 51 and 70 years, who underwent elective myocardial revascularization surgery. The main comorbidities presented were diabetes mellitus, hypertension, and obesity. The infection rates ranged from 2.4% to 38.9%, and the main pathogen identified was Staphylococcus aureus. Conclusion: the main comorbidities present in patients who manifested surgical site infection were diabetes, hypertension, obesity, and smoking. The risk factors were gender, age, and prolonged preoperative hospitalization. Antibiotic prophylaxis, trichotomy, nasal decolonization, and adequate skin antisepsis were the most adopted prophylactic measures. Contributions to practice: knowing the profile of patients who developed infection may favor planning risk control actions.

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Section: Discussionunclassified

Surgical site infection in adult patients after heart procedures: an integrative review

et al. 2022

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“…This is due, among other factors, to the more advanced age and poorer overall condition of patients undergoing cardiac surgery [ 25 ]. 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%

“…Nevertheless, when cardiac surgery is to be performed on an obese patient, it is necessary to adjust the doses of prophylactic antibiotics, thoroughly prepare the surgical site and reinforce the closure of the wound to prevent dehiscence. In addition, some authors recommend sternal closure using negative pressure wound therapy (NPWT) [ 13 , 26 ].…”

Section: Risk Factorsmentioning

confidence: 99%

“…In patients with hyperglycemia who require urgent surgery, perioperative intravenous insulin infusion is the most effective form of rapid glucose control. Most cardiac and thoracic surgery associations and societies, including the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS) and the European Association for Cardio-Thoracic Surgery (EACTS), recommend that perioperative glucose levels in patients undergoing cardiac surgery should be maintained at <180 mg/dL [ 44 , 45 , 46 ], whereas guidelines by the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Spanish Society of Cardiovascular Infections (SEICAV) recommend maintaining intraoperative glucose levels at 110–180 mg/dL [ 26 ].…”

Section: Risk Factorsmentioning

confidence: 99%

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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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“…Recently, Emilo Bouza and associates published a multidisciplinary consensus guideline which included the following proven intervention to reduce SWI : glycaemic control, smoking cessation, weight reduction, incision site preparation with depilatory cream or electric razor to remove the hair and chlorhexidine rather than povidone-based products, screening and eradication of S.aureus, and systematic decontamination when time or other reasons preclude screening. Eradication of S.aureus should be with nasal mupirocin and chlorhexidine for the skin [3].…”

mentioning

confidence: 99%

Predictors of Sternal Wound Infection Post Cardiac Surgery in a Saudi Centre: A Case Control Study

Isaac

2022

Preprint

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Background: Post Cardiac Surgery Sternal Wound Infection (SWI) remains an important cause of extra morbidity, mortality and cost. The objective was to identify risk factors of SWI in a Cardiac Centre in Eastern Saudi Arabia as part of investigation into Surveillance variance in the local rates of SWI. Methods: We included Cases and controls from a cross section of patients who underwent major Cardiac surgery between 2017–2020 matched for age, gender and time of surgery. Explanatory Logistic Regression Model was fitted to estimate the risk factors. Results: N = 204 (51 cases and 153 controls matching ratio 1:3, from a source population of 985 patients). factors significantly associated with SWI in the final Multivariate Model: Hospital stay OR(1.05, Cl 1.01–1.10), Graft Conduit BIMA vs No Graft OR(10.94,Cl 1.60-74.63), transfusion of both packed cells plus other blood products vs no transfusion OR(3.53, Cl .93-13.44), HbA1c OR(1.09 Cl 0.84–1.41), BMI OR(1.25, Cl 1.04–1.50), perioperative Blood Glucose OR(1.02, Cl 1.004–1.03), surgery time OR(1.19, Cl 1.00-1.58). Conclusions: the diverse aetiology, cross disciplinary nature of SWI prevention, and despite improved prevention and control practices including related care bundles with their proven value, SWI remain a serious challenge in Cardiac Surgery. Multidisciplinary consensus guidelines are well overdue.

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Cited by 19 publications

References 304 publications

Surgical site infection in adult patients after heart procedures: an integrative review

Surgical site infection in adult patients after heart procedures: an integrative review

Surgical Site Infection in Cardiac Surgery

Predictors of Sternal Wound Infection Post Cardiac Surgery in a Saudi Centre: A Case Control Study

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