The Occurrence ofStaphylococcus Epidermidisin a Department of Thoracic and Cardiovascular Surgery:A Clinical and Epidemiological Investigation

Abstract

Changes in resistance traits of Staphylococcus epidermidis isolated in the preoperative and postoperative phases from patients undergoing open heart surgery were studied in a two-step prospective investigation. Period 1 comprised 32 patients. All received streptomycin for five days and methicillin for seven days, starting the evening before operation. None of the patients was colonized with multiresistant (MR) strains before or immediately after operation. Two days after operation, in the intensive care unit (ICU) 79% of the patients carried MR S. epidermidis in the nose. Air analyses showed that 30% of the bacteria isolated from the ICU were MR, while such strains were seldom found in the operating theatre. Nose swabs from the staff showed that 26% at the ICU and none in the operating theatre carried MR strains. In an attempt to counteract the selection for MR strains, all patients in period 2 received methicillin alone for only 3 days, and disinfection of the ICU was then performed after each patient. Period 2 comprised 105 patients. The frequency of MR S. epidermidis in the patient material declined from 80% to 40% and from 26% to 15% in the staff members. No changes were found concerning the frequency of postoperative complications. The conclusion is that methicillin alone for three days gives as good a protection against postoperative infections as a more broad-spectrum treatment and that reduced use of antibiotics will reduce the risk of early colonization with resistant strains.

Studies On Coagulase‐Negative Staphylococci In Patients Undergoing Cardiac Surgery

“…This means that a maximum of ten patients (6.8%) could have been colonized with multiplyresistant coagulase-negative staphylococci, according to the two alternative hypotheses (hypotheses 2 and 3), and as the actual post-operative frequency of camers of multiply-resistant staphylococci was 40%, hypothesis 1 was supported in at least 33% of the colonized patients. This supports the rationale of reducing the total amount of antibiotics in the ward, especially to shorten the per-operative treatment with antibiotics and to isolate the patients during this treatment (8).…”

Prospective randomized comparison of cefodizime versus cefuroxime for perioperative prophylaxis in patients undergoing coronary artery bypass grafting

“…However, the high mortality rate of nosocomial infections in patients after cardiac surgery, ranging from 30 to 70% (11,19,27) compared to 3 to 5% in other surgical patient populations (18), implies that there are obviously some adverse effects in aortocoronary bypass grafting. Furthermore, nosocomial infections and multiorgan failure in patients following CPB are frequently associated with opportunistic microorganisms (16,27,29) which additionally induce a dysregulation of the immune response (26,40).…”

Microbiology of postthoractomy sternal wound infection

“…Polymicrobial infection occurred in 18 instances (28%). A single organism was recovered in 47 instances (72%); these included 20 isolates of S. epidermidis, 15 of S. aureus, 5 of Enterobacteriaceae, and 4 of anaerobes. These data highlight the previously unrecognized polymicrobial aerobic and anaerobic bacteriology in a percentage of patients with postthoracotomy sternal wound infection.…”

“…The organisms recognized as causing most of these infections were mostly Staphylococcus aureus, Staphylococcus epidermidis, and members of the family Enterobacteriaceae, such as Escherichia coli, Klebsiella spp., Enterobacter spp., and Proteus spp. (3,5,11). Although anaerobic bacteria were recovered in postsurgical wound infection in the head and neck (8) and abdomen (2), their role in PTSWI was never investigated.…”