Surgical Site Infection in Cardiac Surgery

Abstract

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

Surgical site infection outcomes of two different closed incision negative pressure therapy systems in cardiac surgery: Systematic review and meta‐analysis

“…SSI development following cardiac surgery can be a serious complication resulting in increased morbidity and mortality rates and cost of care 1–5 . ciNPT is available as a post‐surgical tool to help manage the closed incision and has been reported to reduce the incidence of SSI across other surgical specialties.…”

“…5 Risk factors for SSI development in cardiac surgery include high European System for Cardiac Operative Risk Evaluation (EuroSCORE), high Society of Thoracic Surgeons (STS) score, obesity, diabetes, tobacco use, advanced age (>70 years), chronic obstructive pulmonary disease, heart failure with left ventricular dysfunction, renal failure, female sex, peripheral vascular disease and prolonged length of hospital stay prior to surgery. 1,[6][7][8][9] Additionally, emergency surgery, use of bilateral internal mammary arteries, multiple surgery procedures, prolonged surgery duration, duration of cardiopulmonary bypass, aortic clamping, postoperative respiratory failure, transfusion, prolonged intensive care unit stay and use of inotropic support can also increase the risk of SSI development. 1,8 Standard SSI prevention measures (such as blood glucose optimization, tobacco use cessation, prophylactic antibiotic use, nasal and total body bacterial decolonization and sterile surgical field) are commonly utilized before and during surgery 10 ; however, closed incision negative pressure therapy (ciNPT) can offer clinicians a post-surgical tool to help manage the closed surgical incision.…”

“…Reported rates of surgical site infection (SSI) incidence in cardiac surgery have ranged between 0.5% and 25% with mortality rates due to SSIs reaching 25%. [1][2][3][4] More recently, overall rates of SSI development after cardiac surgery have been estimated at 1.7% to 1.9% in the United States based on a retrospective review of the Medicare Limited Data Set and the Premier Healthcare database. 5 Risk factors for SSI development in cardiac surgery include high European System for Cardiac Operative Risk Evaluation (EuroSCORE), high Society of Thoracic Surgeons (STS) score, obesity, diabetes, tobacco use, advanced age (>70 years), chronic obstructive pulmonary disease, heart failure with left ventricular dysfunction, renal failure, female sex, peripheral vascular disease and prolonged length of hospital stay prior to surgery.…”

“…1,[6][7][8][9] Additionally, emergency surgery, use of bilateral internal mammary arteries, multiple surgery procedures, prolonged surgery duration, duration of cardiopulmonary bypass, aortic clamping, postoperative respiratory failure, transfusion, prolonged intensive care unit stay and use of inotropic support can also increase the risk of SSI development. 1,8 Standard SSI prevention measures (such as blood glucose optimization, tobacco use cessation, prophylactic antibiotic use, nasal and total body bacterial decolonization and sterile surgical field) are commonly utilized before and during surgery 10 ; however, closed incision negative pressure therapy (ciNPT) can offer clinicians a post-surgical tool to help manage the closed surgical incision. ciNPT helps hold the incision edges together, reduces lateral tension and provides a barrier against external contamination over an extended time period.…”

“…Cardiac surgery is associated with a high risk of developing postoperative infections. Reported rates of surgical site infection (SSI) incidence in cardiac surgery have ranged between 0.5% and 25% with mortality rates due to SSIs reaching 25% 1–4 . More recently, overall rates of SSI development after cardiac surgery have been estimated at 1.7% to 1.9% in the United States based on a retrospective review of the Medicare Limited Data Set and the Premier Healthcare database 5 …”