Surgical site infections following coronary artery bypass graft procedures: 10 years of surveillance data

Abstract

BackgroundSurgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003–2012, and to identify risk factors for complex sternal site infections.MethodsRoutine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model.ResultsThere were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69).ConclusionsCompared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease.

Nursing Evaluation of Risk Factors Associated with Surgical Site Infection Among Coronary Artery Bypass Graft Patients at King Abdulaziz University Hospital

“…This result is compatible with the findings of the previous studies, which reported that the average age for the development of SSI among the coronary artery bypass graft patients was 60 to 72 years [18]. Different study by [19]. reported that the most patients were males (78.4%) within 58-73 years bracket with average age of 66 years, which is slightly higher than that presented in [18].…”

“…Therefore, this study shows that an increase in body weight increases also the risk of surgical site infection among coronary artery bypass graft patients. Similarly, recorded that an increased body mass index above 35 is a predictor of surgical site infection among the coronary artery bypass graft patients [19]. Therefore, this study established that increased body mass index, especially which is above 25, is a risk factor for surgical site infection among coronary artery bypass graft patients in Saudi Arabia.…”

“…All the sampled patients were cultured and the results were negative for Methicillin-Resistant Staphylococcus Aurous. This finding is against that of study (2014),indicated that Methicillin-Resistant Staphylococcus Aurous is one of the common pathogens causing infection for 14.6% of all surgical sites, 20% of all sternal site infections and increases the length of hospital stay for all patients after coronary artery bypass graft [19].Similarly, with this finding that Methicillin-Resistant Staphylococcus Aurous causes deep sternum infections and proposes preoperative Methicillin-Resistant Staphylococcus Aurous culturing as important to prevent infections and associated high morbidity and mortality rates [34].…”

A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting

“…2 It has also been reported that most harvest-site SSIs are identified only in the outpatient setting, suggesting that some published rates may be underestimated. 3 Historically, few studies have assessed preventative strategies directed at harvest-site SSIs; however, approaches such as the use of a minimally invasive vein harvest technique, topical application of autologous platelet-rich plasma, and use of a microbial skin sealant have recently been evaluated. 1,[4][5][6] The source of most pathogens causative of SSI is the endogenous flora, primarily the patient's skin.…”

Methodology of the Norwegian Surveillance System for Healthcare-Associated Infections: The value of a mandatory system, automated data collection, and active postdischarge surveillance

“…Some have shown that it takes time to achieve the "surveillance effect" 44,45,[100][101][102] and that the greatest effect is in the first few years, 37,100 whereas others do not find an effect over time. 103,104 The UK and France, 74,105 like Norway, have systems where surveillance is only required for some months of the year. 106 Both these countries show a reduction in the incidence proportions only for some procedures in the ECDC reports, and may be experiencing the same issue as with the Norwegian data.…”