Staphylococcus aureus poststernotomy mediastinitis: Description of two distinct acquisition pathways with different potential preventive approaches

Juan, Rafael San; Cháves, Fernando; Gude, María Jesús López; Díaz-Pedroche, Carmen; Otero, Joaquín R.; Romero, José María; Rufilanchas, Juan J.; Aguado, José María

doi:10.1016/j.jtcvs.2007.04.010

Cited by 28 publications

(7 citation statements)

References 18 publications

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“…In group SWI w/oPDT , the most frequently isolated pathogens from SWIs were gram-positive staphylococci (CNS 40 %, followed by S. aureus 29 %). These findings are consistent with numerous studies [ 5 – 10 ]. In these studies, the incidence of fungi in SWI was reported to range between 1 and 5 %.…”

Section: Discussionsupporting

confidence: 94%

“…The incidence of deep sternal wound infection (DSWI) and mediastinitis have been reported to range between 0.16–3.20 % and 1–3 %, respectively [ 1 , 3 , 4 ]. The most common microbiological pathogens found in infected sternal wounds are gram-positive staphylococci ( Staphylococcus aureus and coagulase-negative staphylococci ) followed by gram-negative species [ 5 – 10 ]. Candida spp .…”

Section: Introductionmentioning

confidence: 99%

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Does percutaneous dilatational tracheostomy increase the incidence of sternal wound infection - a single center retrospective of 4100 cases

Tewarie

Zayat

Haefner

et al. 2015

J Cardiothorac Surg

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BackgroundThe impact of percutaneous dilatational tracheostomy (PDT) on the development of post-median sternotomy wound infection (SWI) and mediastinitis is still controversial. We aimed to investigate the frequency of cross-infection and incidence of SWI after PDT.MethodsIn a retrospective design, out of a total of 4100 procedures, all patients who had undergone median sternotomy and postoperative PDT were included from January 2010 to May 2013. For comparison of the pathogens isolated from SWIs, data from all patients who developed an SWI without a PDT during the aforementioned period were also analyzed. Demographical, pre-, peri- and post-operative data were compared. Microbiologic analysis from cultures of sternal and tracheal wounds was performed. Day and duration of tracheostomy were correlated to SWI occurrence.ResultsOf the 265 patients who underwent a PDT, 25 (9.4 %) developed an SWI. In this cohort, identical pathogens were isolated from the tracheostomy and SWI in 36 % (9/25) of the patients. Of the pathogens isolated from the SWIs from the PDT + SWI group, 60 % were gram-positive bacteria, 20 % gram-negative bacteria and 20 % Candida spp. In the cross-infection group, the patients developed the following types of SWIs: 11.1 % CDC I, 55.6 % CDC II and 33.3 % mediastinitis (CDC III). The incidence of SWI in the group SWI + PDT was 9.4 % (9.4 % vs. 3.4 %, PDT + SWI and SWIw/oPDT, respectively, p = 0.0001). In group SWIw/oPDT, only 1.5 % (2/131 vs. 5/25; p = 0.001) Candida spp were isolated from SWI. The infection-related in-hospital mortality was high in groups PDT + SWI vs. SWIw/oPDT (20 % vs. 0 %, respectively; p = 0.0001). The statistical analysis did not demonstrate any correlation between time of performing PDT and occurrence of SWI.ConclusionsThere was a high incidence of microbial cross-infection from the PDTs to the sternal wounds in our study. We did not detect any correlation between the time of performing PDT and occurrence of SWI. According to our data, PDT seems to increase the incidence of SWI, especially caused by Candida spp., after cardiac surgery, which results in a prolonged hospital stay. Therefore, early antifungal prophylaxis after a PDT might be reasonable in high-risk patients on long-term mechanical ventilation if there is an impending SWI.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Does percutaneous dilatational tracheostomy increase the incidence of sternal wound infection - a single center retrospective of 4100 cases

Tewarie

Zayat

Haefner

et al. 2015

J Cardiothorac Surg

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“…Recently, however, a significantly lower incidence of SWD (1%) has been reported [1] , probably because of the introduction of treatment in the entire group, although it has not reached statistical significance. S. aureus was the most commonly isolated germ from wound cultures in this study, although still less frequently than reported by others [15,23,24] .…”

Section: Commentcontrasting

confidence: 52%

Sternal Wound Complications: Results of Routine Use of Negative Pressure Wound Therapy

Martino¹,

Re²,

Falcetta³

et al. 2020

Braz J Cardiovasc Surg

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Introduction: Negative pressure wound therapy (NPWT) has significantly improved outcomes in individuals with superficial and deep sternal wound dehiscence (SWD). We report our experience with NPWT to evaluate factors influencing effectiveness, duration of treatment and postoperative hospital stay. Methods: We reviewed 92 patients with postoperative SWD following a median sternotomy. Patients were divided into 2 groups: those with a superficial SWD (Group 1; 72, 78%) and those with a deep SWD (Group 2; 20, 28%). Group 1 was further divided into 3 subgroups based on NPWT duration. Results: In both groups, none of the preoperative characteristics examined showed a significant association with longer NPWT duration. In Group 2, there was a trend for postoperative bleeding and neurological complications to be associated with longer treatment duration. In the entire series, staph infection resulted a weak predictor of NPWT duration. In each Group 1 subgroup and in Group 2, treatment days were compared with duration of hospitalization until discharge. Mean post-NPWT hospital stay was 6 days in subgroup 1, 12 days in subgroup 2 and 20 days in subgroup 3 (P<0.0001). At a median 3-year follow-up, there were 4 late deaths, none related to wound complications. No cases of SWD recurrence were observed. Conclusion: Our results confirm the effectiveness of NPWT in SWD management, while excessive treatment duration might have a negative impact on the length of hospital stay. Further studies are needed to define an optimal use of NPWT protocol.

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“…Las características microbiológicas en este estudio no son exactamente las reportadas previamente. [29][30][31][32][33][34][35][36] A pesar de ello, se observó un alto porcentaje de aislamientos monomicrobianos y pocos aislamientos polimicrobianos, lo cual es consistente con informes previos. En nuestro reporte, la frecuencia de microorganismos…”

Section: Resultsunclassified

“…aislados fue de 67 %; la microbiota de piel fueron los principales microorganismos involucrados. La colonización nasal por Staphyloccocus aureus precede con frecuencia a la mediastinitis posesternotomía; en nuestro estudio se identificó este factor de riesgo en 33.3 % de los pacientes y en otras investigaciones se reporta una colonización mayor de 52.9 %, 36 sin embargo, se describe que no todos los pacientes colonizados desarrollan mediastinitis y que pacientes no colonizados pueden presentar esta complicación. Lo anterior refleja que otros factores independientes contribuyen a su desarrollo.…”

Section: Enterobacter Aerogenes 2unclassified

Microorganisms isolated in patients with post-cardiac surgery mediastinitis at a cardiology hospital of Mexico City

Jiménez-González¹,

Mejía-Aguirre²,

Ascencio-Montiel³

2023

GMM

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Introducción: La mediastinitis posterior a cirugía cardiovascular deriva en estancia hospitalaria prolongada e incremento de los costos de la atención médica, y se asocia a elevada letalidad hospitalaria. Objetivo: Describir las características clínicas de los pacientes con mediastinitis posquirúrgica, incluyendo los microorganismos aislados, perfil de resistencia y supervivencia hospitalaria. Métodos: Estudio transversal de pacientes con mediastinitis posquirúrgica bacteriológicamente confirmada, atendidos en un hospital de cardiología de la Ciudad de México entre enero de 2017 y marzo de 2019. Resultados: Se incluyeron 58 casos de mediastinitis. La mediana de edad fue de 67 años. La mayoría de los sujetos fueron varones sometidos a revascularización miocárdica. Durante el seguimiento hospitalario, la letalidad por todas las causas y la secundaria a la mediastinitis fueron de 27.6 y 20.7 %, respectivamente. Los microorganismos más frecuentemente aislados fueron Staphylococcus aureus, Staphylococcus epidermidis y Escherichia coli. Se encontró alta resistencia a meticilina en los estafilococos coagulasa negativos y alta expresión de betalactamasas de espectro extendido en cepas de Escherichia coli y Klebsiella pneumoniae. Conclusiones: En los pacientes con mediastinitis posquirúrgica analizados se observó alta letalidad e importante resistencia antimicrobiana.

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Staphylococcus aureus poststernotomy mediastinitis: Description of two distinct acquisition pathways with different potential preventive approaches

Cited by 28 publications

References 18 publications

Does percutaneous dilatational tracheostomy increase the incidence of sternal wound infection - a single center retrospective of 4100 cases

Does percutaneous dilatational tracheostomy increase the incidence of sternal wound infection - a single center retrospective of 4100 cases

Sternal Wound Complications: Results of Routine Use of Negative Pressure Wound Therapy

Microorganisms isolated in patients with post-cardiac surgery mediastinitis at a cardiology hospital of Mexico City

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