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Circulating 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Concentrations and Postoperative Infections in Cardiac Surgical Patients: The CALCITOP-Study. PLoS One 2016; 11:e0158532. [PMID: 27355377 PMCID: PMC4927161 DOI: 10.1371/journal.pone.0158532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Vitamin D has immunomodulatory properties and seems to reduce the risk of infections. Whether low vitamin D concentrations are independent risk factors for nosocomial postoperative infections in surgical patients remains to be studied in detail. METHODS In 3,340 consecutive cardiac surgical patients, we investigated the association of circulating 25-hydroxyvitamin D (25OHD; indicator of nutritional vitamin D status) and 1,25-dihydroxyvitamin D (1,25[OH]2D; active vitamin D hormone) with nosocomicial infections. The primary endpoint was a composite of thoracic wound infection, sepsis, and broncho-pulmonary infection. Vitamin D status was measured on the last preoperative day. Infections were assessed until discharge. Logistic regression analysis was used to examine the association between vitamin D metabolite concentrations and the composite endpoint. RESULTS The primary endpoint was reached by 5.6% (n = 186). In patients who reached and did not reach the endpoint, in-hospital mortality was 13.4% and 1.5%, respectively (P<0.001). Median (IQR) 25OHD and 1,25(OH)2D concentrations were 43. 2 (29.7-61.9) nmol/l and 58.0 (38.5-77.5) pmol/l, respectively. Compared with the highest 1,25(OH)2D quintile (>81.0 pmol/l), the multivariable-adjusted odds ratio of infection was 2.57 (95%CI:1.47-4.49) for the lowest 1,25(OH)2D quintile (<31.5 pmol/l) and 1.85 (95%CI:1.05-3.25) for the second lowest quintile (31.5-49.0 pmol/l). There was no significant association between 25OHD concentrations and the primary endpoint. CONCLUSIONS Our data indicate an independent association of low 1,25(OH)2D levels with the risk of postoperative infections in cardiac surgical patients. Future studies should pay more attention on the clinical relevance of circulating 1,25(OH)2D and its regulation.
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Rapetto F, Bruno VD, Guida G, Marsico R, Chivasso P, Zebele C. Gentamicin-Impregnated Collagen Sponge: Effectiveness in Preventing Sternal Wound Infection in High-Risk Cardiac Surgery. Drug Target Insights 2016; 10:9-13. [PMID: 27279734 PMCID: PMC4886695 DOI: 10.4137/dti.s39077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/05/2016] [Accepted: 04/11/2016] [Indexed: 11/13/2022] Open
Abstract
Sternal wound infections represent one of the most frequent complications after cardiac surgery and are associated with high postoperative mortality. Several preventive methods have been introduced, and recently, gentamicin-impregnated collagen sponges (GICSs) have shown a promising effect in reducing the incidence of this type of complications. Gentamicin is an aminoglycoside antibiotic that has been widely used to treat infections caused by multiresistant bacteria; despite its effectiveness, its systemic use carries a risk of toxicity. GICSs appear to overcome this side effect, topically delivering high antibiotic concentrations to the wound and thus reducing the toxic-related events. Although several retrospective analyses and randomized controlled trials have studied the use of GICSs in cardiac surgery, conclusions regarding their efficacy in preventing sternal wound infection are inconsistent. We have reviewed the current literature focusing on high-risk patients.
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Affiliation(s)
- Filippo Rapetto
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Vito D Bruno
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Gustavo Guida
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Roberto Marsico
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Carlo Zebele
- Department of Cardiac Surgery, Citta' di Lecce Hospital, Lecce, Italy
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Wetzstein N, Brodt HR. Perioperative Antiinfektivaprophylaxe in der Kardiochirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-015-0056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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O'Neal PB, Itani KMF. Antimicrobial Formulation and Delivery in the Prevention of Surgical Site Infection. Surg Infect (Larchmt) 2016; 17:275-85. [PMID: 26910558 DOI: 10.1089/sur.2015.272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A number of adjunct antimicrobial measures have been studied in an attempt to reduce surgical site infection (SSI) rates. In addition to parenteral antibiotic prophylaxis, these measures include oral antibiotics in bowel preparation for colorectal surgery, antiseptic/antimicrobial irrigation, antimicrobial sutures, local antibiotics, skin incision antibacterial sealants, and antimicrobial dressings. It is the purpose of this review to study the evidence behind each of these measures and to evaluate relevant data for recommendations in each area. METHODS A systematic review of the literature through PubMed was performed. RESULTS Need for adequate dosing and re-dosing of intravenous peri-operative antibiotics, duration of antibiotic usage past wound closure, and the use of antibiotic bowel preparation in colorectal surgery are well defined in the published literature. However, data on local antimicrobial measures remain controversial. CONCLUSIONS Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable.
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Affiliation(s)
- Patrick B O'Neal
- 1 Veterans Administration Boston Health Care System , West Roxbury, Massachusetts.,2 Department of Surgery, Boston University , Boston, Massachusetts
| | - Kamal M F Itani
- 1 Veterans Administration Boston Health Care System , West Roxbury, Massachusetts.,2 Department of Surgery, Boston University , Boston, Massachusetts
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Andersen ND. Antibiotic prophylaxis in cardiac surgery: If some is good, how come more is not better? J Thorac Cardiovasc Surg 2016; 151:598-9. [DOI: 10.1016/j.jtcvs.2015.10.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
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Meszaros K, Fuehrer U, Grogg S, Sodeck G, Czerny M, Marschall J, Carrel T. Risk Factors for Sternal Wound Infection After Open Heart Operations Vary According to Type of Operation. Ann Thorac Surg 2015; 101:1418-25. [PMID: 26652136 DOI: 10.1016/j.athoracsur.2015.09.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study evaluated whether risk factors for sternal wound infections vary with the type of surgical procedure in cardiac operations. METHODS This was a university hospital surveillance study of 3,249 consecutive patients (28% women) from 2006 to 2010 (median age, 69 years [interquartile range, 60 to 76]; median additive European System for Cardiac Operative Risk Evaluation score, 5 [interquartile range, 3 to 8]) after (1) isolated coronary artery bypass grafting (CABG), (2) isolated valve repair or replacement, or (3) combined valve procedures and CABG. All other operations were excluded. Univariate and multivariate binary logistic regression were conducted to identify independent predictors for development of sternal wound infections. RESULTS We detected 122 sternal wound infections (3.8%) in 3,249 patients: 74 of 1,857 patients (4.0%) after CABG, 19 of 799 (2.4%) after valve operations, and 29 of 593 (4.9%) after combined procedures. In CABG patients, bilateral internal thoracic artery harvest, procedural duration exceeding 300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female sex (model 1) were independent predictors for sternal wound infection. A second model (model 2), using the European System for Cardiac Operative Risk Evaluation, revealed bilateral internal thoracic artery harvest, diabetes, obesity, and the second and third quartiles of the European System for Cardiac Operative Risk Evaluation were independent predictors. In valve patients, model 1 showed only revision for bleeding as an independent predictor for sternal infection, and model 2 yielded both revision for bleeding and diabetes. For combined valve and CABG operations, both regression models demonstrated revision for bleeding and duration of operation exceeding 300 minutes were independent predictors for sternal infection. CONCLUSIONS Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, duration of operation) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female sex) are predictive of sternal wound infection. Preventive interventions may be justified according to the type of operation.
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Affiliation(s)
- Katharina Meszaros
- Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland; Department for General Surgery, Medical University of Graz, Graz, Austria
| | - Urs Fuehrer
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sina Grogg
- Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland
| | - Gottfried Sodeck
- Department of Emergency Medicine, Medical University Vienna, Vienna, Austria
| | - Martin Czerny
- Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital Bern, Bern, Switzerland.
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del Diego Salas J, Orly de Labry Lima A, Espín Balbino J, Bermúdez Tamayo C, Fernández-Crehuet Navajas J. An economic evaluation of two interventions for the prevention of post-surgical infections in cardiac surgery. ACTA ACUST UNITED AC 2015; 31:27-33. [PMID: 26602758 DOI: 10.1016/j.cali.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 07/02/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To conduct a cost-effectiveness analysis that compares two prophylactic protocols for treating post-surgical infections in cardiac surgery. METHODS A cost effectiveness analysis was done by using a decision tree to compare two protocols for prophylaxis of post-surgical infections (Protocol A: Those patient with positive test to methicillin-resistant Staphylococcus aureus (MRSA) colonization received muripocin (twice a day during a two-week period), with no follow-up verification. Those who tested negative did not receive the prophylaxis treatment; Protocol B: all patients received the mupirocin treatment). The number of post-surgical infections averted was the measure of effectiveness from the health system's perspective, 30 days following the surgery. The incidence of infections and complications was obtained from two cohorts of patients who underwent cardiac surgery Hospital. The times for applying the two protocols were validated by experts. They cost were calculated from the hospital's analytical accounting management system and Pharmaceutical Service. Only direct costs were taken into account, no discount rates were applied. Incremental cost-effectiveness ratio (ICER) was calculated. A probabilistic sensitivity analysis was performed. RESULTS A total of 1118 patients were included (721 in Protocol A and 397 in Protocol B). No statistically significant differences were found in age, sex, diabetes, exitus or length of hospital stay between the two protocols. In the control group the rate of infection was 15.3%, compared with 11.3% in the intervention group. Protocol B proves to be more effective and at a lower cost, yielding an ICER of €32,506. CONCLUSION Universal mupirocin prophylaxis against surgical site infections (SSI) in cardiac surgery as a dominant strategy, because it shows a lower incidence of infections and cost savings, versus the strategy to treat selectively patients according to their test results prior screening.
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Affiliation(s)
- J del Diego Salas
- Department of Preventive Medicine, Virgen de la Victoria University Hospital, Malaga, Spain
| | - A Orly de Labry Lima
- Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, Granada, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Spain.
| | - J Espín Balbino
- Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, Granada, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Spain
| | - C Bermúdez Tamayo
- Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, Granada, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Spain; Institute de Recherche en Santé Publique, Université de Montréal, Canada
| | - J Fernández-Crehuet Navajas
- Department of Preventive Medicine, Virgen de la Victoria University Hospital, Malaga, Spain; Department of Preventive Medicine, University of Malaga, Malaga, Spain
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Paternoster G, Guarracino F. Sepsis After Cardiac Surgery: From Pathophysiology to Management. J Cardiothorac Vasc Anesth 2015; 30:773-80. [PMID: 26947713 DOI: 10.1053/j.jvca.2015.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Gianluca Paternoster
- U.O.C. Cardiac Anaesthesia and Cardiac-Intensive Care, San Carlo Hospital, Potenza, Italy.
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med 2015; 4:265-273. [PMID: 26557476 PMCID: PMC4631871 DOI: 10.5492/wjccm.v4.i4.265] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/18/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a “bridge” prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate.
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Poeran J, Mazumdar M, Rasul R, Meyer J, Sacks HS, Koll BS, Wallach FR, Moskowitz A, Gelijns AC. Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2015; 151:589-97.e2. [PMID: 26545971 DOI: 10.1016/j.jtcvs.2015.09.090] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Antibiotic use, particularly type and duration, is a crucial modifiable risk factor for Clostridium difficile. Cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. We aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and C difficile among patients undergoing coronary artery bypass grafting. METHODS We extracted data on coronary artery bypass grafting procedures from the national Premier Perspective claims database (2006-2013, n = 154,200, 233 hospitals). Multilevel multivariable logistic regressions measured associations between (1) duration (<2 days, "standard" vs ≥2 days, "extended") and (2) type of antibiotic used ("cephalosporin," "cephalosporin + vancomycin," "vancomycin") and C difficile as outcome. RESULTS Overall C difficile prevalence was 0.21% (n = 329). Most patients (59.7%) received a cephalosporin only; in 33.1% vancomycin was added, whereas 7.2% received vancomycin only. Extended prophylaxis was used in 20.9%. In adjusted analyses, extended prophylaxis (vs standard) was associated with significantly increased C difficile risk (odds ratio, 1.43; confidence interval, 1.07-1.92), whereas no significant associations existed for vancomycin use as adjuvant or primary prophylactic compared with the use of cephalosporins (odds ratio, 1.21; confidence interval, 0.92-1.60, and odds ratio, 1.39; confidence interval, 0.94-2.05, respectively). Substantial inter-hospital variation exists in the percentage of extended antibiotic prophylaxis (interquartile range, 2.5-35.7), use of adjuvant vancomycin (interquartile range, 4.2-61.1), and vancomycin alone (interquartile range, 2.3-10.4). CONCLUSIONS Although extended use of antibiotic prophylaxis was associated with increased C difficile risk after coronary artery bypass grafting, vancomycin use was not. The observed hospital variation in antibiotic prophylaxis practices suggests great potential for efforts aimed at standardizing practices that subsequently could reduce C difficile risk.
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Affiliation(s)
- Jashvant Poeran
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rehana Rasul
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joanne Meyer
- Department of Pharmacy, The Mount Sinai Hospital, New York, NY
| | - Henry S Sacks
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brian S Koll
- Icahn School of Medicine at Mount Sinai, New York, NY; Infection Prevention and Control, Mount Sinai Health System, New York, NY
| | - Frances R Wallach
- Icahn School of Medicine at Mount Sinai, New York, NY; Infection Prevention and Control, Mount Sinai Health System, New York, NY
| | - Alan Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Claret G, Tornero E, Martínez-Pastor JC, Piazuelo M, Martínez J, Bosch J, Mensa J, Soriano A. A Prolonged Post-Operative Antibiotic Regimen Reduced the Rate of Prosthetic Joint Infection after Aseptic Revision Knee Arthroplasty. Surg Infect (Larchmt) 2015; 16:775-80. [PMID: 26241469 DOI: 10.1089/sur.2015.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the prosthetic joint infection (PJI) rate after knee revision arthroplasty in two consecutive periods with different antibiotic prophylaxis: short (one day) versus long (five days). METHODS From January 2007 to September 2010 antibiotic prophylaxis consisted of 800 mg of teicoplanin and 2 g of ceftazidime intravenously and 1 g of ceftazidime two hours after the first dose. From October 2010, it was prolonged post-operatively using vancomycin and ceftazidime intravenously until the fifth day. RESULTS During the study period, 341 revision surgeries met the inclusion criteria. The PJI rate was lower in the long-prophylaxis group (2.2% versus 6.9%, p=0.049). Prolonged post-operative antibiotic treatment was the only variable associated independently with a lower rate of PJI (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.07-0.99).
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Affiliation(s)
- Guillem Claret
- 1 Departments of Orthopedic Surgery, Hospital Clínic of Barcelona , Spain, Barcelona, Spain
| | - Eduard Tornero
- 1 Departments of Orthopedic Surgery, Hospital Clínic of Barcelona , Spain, Barcelona, Spain
| | | | - Mercè Piazuelo
- 1 Departments of Orthopedic Surgery, Hospital Clínic of Barcelona , Spain, Barcelona, Spain
| | - Jésica Martínez
- 1 Departments of Orthopedic Surgery, Hospital Clínic of Barcelona , Spain, Barcelona, Spain
| | - Jordi Bosch
- 2 Service of Infectious Diseases, Hospital Clínic of Barcelona, Spain, IDIBAPS, University of Barcelona , Barcelona, Spain
| | - Josep Mensa
- 2 Service of Infectious Diseases, Hospital Clínic of Barcelona, Spain, IDIBAPS, University of Barcelona , Barcelona, Spain
| | - Alex Soriano
- 2 Service of Infectious Diseases, Hospital Clínic of Barcelona, Spain, IDIBAPS, University of Barcelona , Barcelona, Spain
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Invited commentary. Ann Thorac Surg 2015; 99:1600. [PMID: 25952195 DOI: 10.1016/j.athoracsur.2015.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 01/08/2015] [Accepted: 01/15/2015] [Indexed: 11/24/2022]
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Hamouda K, Oezkur M, Sinha B, Hain J, Menkel H, Leistner M, Leyh R, Schimmer C. Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: an observational study. J Cardiothorac Surg 2015; 10:25. [PMID: 25880032 PMCID: PMC4345000 DOI: 10.1186/s13019-015-0225-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/10/2015] [Indexed: 11/25/2022] Open
Abstract
Background All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac surgery patients were assigned to one of two groups receiving PAB with a second-generation cephalosporin for either 56 h (group I) or 32 h (group II). Patients’ characteristics, intraoperative data, and the in-hospital follow-up were analysed. Primary endpoint was the incidence of surgical site infection (deep and superficial sternal wound-, and vein harvesting site infection; DSWI/SSWI/VHSI). Secondary endpoints were the incidence of respiratory-, and urinary tract infection, as well as the mortality rate. Results 615/1096 patients (56,1%) were enrolled (group I: n = 283 versus group II: n = 332). There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. No statistically significant differences were demonstrated concerning primary and secondary endpoints. The incidence of DSWI/SSWI/VHSI were 4/283 (1,4%), 5/283 (1,7%), and 1/283 (0,3%) in group I versus 6/332 (1,8%), 9/332 (2,7%), and 3/332 (0,9%) in group II (p = 0,76/0,59/0,63). In univariate analyses female gender, age, peripheral arterial obstructive disease, operating-time, ICU-duration, transfusion, and respiratory insufficiency were determinants for nosocomial infections (all ≤ 0,05). Subgroup analyses of these high-risk patients did not show any differences between the two regimes (all ≥ 0,05). Conclusions Reducing the duration of PAB from 56 h to 32 h in adult cardiac surgery patients was not associated with an increase of nosocomial infection rate, but contributes to reduce antibiotic resistance and health care costs.
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Affiliation(s)
- Khaled Hamouda
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Mehmet Oezkur
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Bhanu Sinha
- Medical Microbiology, University Medical Center Groningen, Groningen, Netherlands.
| | - Johannes Hain
- University of Würzburg, Institute of Mathematics and Informatics, Chair of Mathematics VIII (Statistics), Würzburg, Germany.
| | - Hannah Menkel
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Marcus Leistner
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Rainer Leyh
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Christoph Schimmer
- Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
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Glycopeptides Versus β-Lactams for the Prevention of Surgical Site Infections in Cardiovascular and Orthopedic Surgery. Ann Surg 2015; 261:72-80. [DOI: 10.1097/sla.0000000000000704] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Szelkowski LA, Puri NK, Singh R, Massimiano PS. Current trends in preoperative, intraoperative, and postoperative care of the adult cardiac surgery patient. Curr Probl Surg 2015; 52:531-69. [DOI: 10.1067/j.cpsurg.2014.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD, Perrault LP, Smith PK, Kron IL, Michler RE, Miller MA, Gardner TJ, Ascheim DD, Ailawadi G, Lackner P, Goldsmith LA, Robichaud S, Miller RA, Rose EA, Ferguson TB, Horvath KA, Moquete EG, Parides MK, Bagiella E, O'Gara PT, Blackstone EH. Management practices and major infections after cardiac surgery. J Am Coll Cardiol 2014; 64:372-81. [PMID: 25060372 DOI: 10.1016/j.jacc.2014.04.052] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/24/2014] [Accepted: 04/03/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Infections are the most common noncardiac complication after cardiac surgery, but their incidence across a broad range of operations, as well as the management factors that shape infection risk, remain unknown. OBJECTIVES This study sought to prospectively examine the frequency of post-operative infections and associated mortality, and modifiable management practices predictive of infections within 65 days from cardiac surgery. METHODS This study enrolled 5,158 patients and analyzed independently adjudicated infections using a competing risk model (with death as the competing event). RESULTS Nearly 5% of patients experienced major infections. Baseline characteristics associated with increased infection risk included chronic lung disease (hazard ratio [HR]: 1.66; 95% confidence interval [CI]: 1.21 to 2.26), heart failure (HR: 1.47; 95% CI: 1.11 to 1.95), and longer surgery (HR: 1.31; 95% CI: 1.21 to 1.41). Practices associated with reduced infection risk included prophylaxis with second-generation cephalosporins (HR: 0.70; 95% CI: 0.52 to 0.94), whereas post-operative antibiotic duration >48 h (HR: 1.92; 95% CI: 1.28 to 2.88), stress hyperglycemia (HR: 1.32; 95% CI: 1.01 to 1.73); intubation time of 24 to 48 h (HR: 1.49; 95% CI: 1.04 to 2.14); and ventilation >48 h (HR: 2.45; 95% CI: 1.66 to 3.63) were associated with increased risk. HRs for infection were similar with either <24 h or <48 h of antibiotic prophylaxis. There was a significant but differential effect of transfusion by surgery type (excluding left ventricular assist device procedures/transplant) (HR: 1.13; 95% CI: 1.07 to 1.20). Major infections substantially increased mortality (HR: 10.02; 95% CI: 6.12 to 16.39). CONCLUSIONS Major infections dramatically affect survival and readmissions. Second-generation cephalosporins were strongly associated with reduced major infection risk, but optimal duration of antibiotic prophylaxis requires further study. Given practice variations, considerable opportunities exist for improving outcomes and preventing readmissions. (Management Practices and Risk of Infection Following Cardiac Surgery; NCT01089712).
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Affiliation(s)
- Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York.
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Michael A Acker
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nancy L Geller
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - John D Puskas
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Louis P Perrault
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Peter K Smith
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert E Michler
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Marissa A Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Timothy J Gardner
- Center for Heart & Vascular Health, Christiana Care Health System, Newark, Delaware
| | - Deborah D Ascheim
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Pamela Lackner
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lyn A Goldsmith
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Sophie Robichaud
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Rachel A Miller
- Department of Medicine, Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Eric A Rose
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York
| | - T Bruce Ferguson
- Department of Cardiovascular Sciences; East Carolina Heart Institute at East Carolina University, Greenville, North Carolina
| | | | - Ellen G Moquete
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Michael K Parides
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Health Evidence and Policy, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Patrick T O'Gara
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Gorski A, Hamouda K, Özkur M, Leistner M, Sommer SP, Leyh R, Schimmer C. Cardiac surgery antibiotic prophylaxis and calculated empiric antibiotic therapy. Asian Cardiovasc Thorac Ann 2014; 23:282-8. [PMID: 25061221 DOI: 10.1177/0218492314546028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ongoing debate exists concerning the optimal choice and duration of antibiotic prophylaxis as well as the reasonable calculated empiric antibiotic therapy for hospital-acquired infections in critically ill cardiac surgery patients. METHODS A nationwide questionnaire was distributed to all German heart surgery centers concerning antibiotic prophylaxis and the calculated empiric antibiotic therapy. RESULTS The response to the questionnaire was 87.3%. All clinics that responded use antibiotic prophylaxis, 79% perform it not longer than 24 h (single-shot: 23%; 2 doses: 29%; 3 doses: 27%; 4 doses: 13%; and >5 doses: 8%). Cephalosporin was used in 89% of clinics (46% second-generation, 43% first-generation cephalosporin). If sepsis is suspected, the following diagnostics are performed routinely: wound inspection 100%; white blood cell count 100%; radiography 99%; C-reactive protein 97%; microbiological testing of urine 91%, blood 81%, and bronchial secretion 81%; procalcitonin 74%; and echocardiography 75%. The calculated empiric antibiotic therapy (depending on the suspected focus) consists of a multidrug combination with broad-spectrum agents. CONCLUSION This survey shows that existing national guidelines and recommendations concerning perioperative antibiotic prophylaxis and calculated empiric antibiotic therapy are well applied in almost all German heart centers.
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Affiliation(s)
- Armin Gorski
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Khaled Hamouda
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Mehmet Özkur
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Markus Leistner
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Sebastian-Patrick Sommer
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Rainer Leyh
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Schimmer
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
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Mishra PK, Ashoub A, Salhiyyah K, Aktuerk D, Ohri S, Raja SG, Luckraz H. Role of topical application of gentamicin containing collagen implants in cardiac surgery. J Cardiothorac Surg 2014; 9:122. [PMID: 25005533 PMCID: PMC4227288 DOI: 10.1186/1749-8090-9-122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/28/2014] [Indexed: 11/14/2022] Open
Abstract
Sternal wound infections (SWI) continue to be a major cause of concern after cardiac surgery. It leads to prolonged hospital stay and increased morbidity, mortality and increased hospital costs. Prophylactic systemic antibiotics have been used to prevent surgical site infection (SSI). However, prolonged postoperative use of systemic antibiotics can lead to emergence of resistant organisms. Gentamycin Containing Collagen Implants (GCCI) when used during sternotomy closure produces high local antibiotic concentrations in the wound with a low serum concentration. There is evidence that the concentration of gentamicin in the mediastinal fluid reaches levels high enough to be effective against bacteria that are considered resistant to gentamycin and other antibiotics.However, questions have been raised about the safety and efficacy of GCCI. There were concerns whether GCCI can lead to systemic absorption with renal impairment and whether use of topical antibiotics can lead to emergence of antimicrobial resistance.We, hereby, review the literature on GCCI (Collatamp) and take the opportunity to appraise the scientific community about their role in cardiac surgery. Several recent studies have supported their clinical effectiveness. They should be used in dry condition and should not be soaked in saline even for a short period prior to use. However, for GCCI to become part of routine practice in cardiac surgery further large randomised studies are required. As the incidence of sternal wound infection is low in the specialty of cardiac surgery, for any study to be sufficiently powered to address this issue, multicenter studies might be the way forward.Based on the evidence presented in this manuscript it is recommended GCCI (Collatamp) can be a cost effective adjunct for prevention of sternal wound infection. They can also be used for treatment of Deep Sternal Wound Infection.
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Affiliation(s)
- Pankaj Kumar Mishra
- Cardiothoracic Unit, Heart and Lung Centre, Wednesfield Road, Wolverhampton WV10 0QP, UK
| | - Ahmed Ashoub
- Wessex Cardiothoracic Centre, Tremona Road, Southampton SO16 6Y, UK
| | - Kareem Salhiyyah
- Wessex Cardiothoracic Centre, Tremona Road, Southampton SO16 6Y, UK
| | - Dincer Aktuerk
- Cardiothoracic Unit, Heart and Lung Centre, Wednesfield Road, Wolverhampton WV10 0QP, UK
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, Tremona Road, Southampton SO16 6Y, UK
| | | | - Heyman Luckraz
- Cardiothoracic Unit, Heart and Lung Centre, Wednesfield Road, Wolverhampton WV10 0QP, UK
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A predisposition for sepsis after cardiac surgery-but what to do? Crit Care Med 2014; 42:1287-8. [PMID: 24736338 DOI: 10.1097/ccm.0000000000000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lepelletier D, Bourigault C, Roussel J, Lasserre C, Leclère B, Corvec S, Pattier S, Lepoivre T, Baron O, Despins P. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect 2013; 43:403-9. [DOI: 10.1016/j.medmal.2013.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 06/20/2013] [Accepted: 07/19/2013] [Indexed: 12/20/2022]
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Unai S, Miessau J, Karbowski P, Bajwa G, Hirose H. Sternal wound infection caused by Mycobacterium chelonae. J Card Surg 2013; 28:687-92. [PMID: 23941599 DOI: 10.1111/jocs.12194] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Sternal wound infection caused by Mycobacterium chelonae, a member of the rapidly growing nontuberculous mycobacteria (NTM), is rare and may present without signs and symptoms of systemic infection. METHODS We present a patient who had a M. chelonae infection of the sternum following excision of a left atrial myxoma and conducted a review of the literature from 1976 to 2013. RESULTS Seventy cases of NTM sternal wound infection after cardiac surgery were identified, including six outbreaks and ten sporadic cases including the present case. Thirty-four cases were isolated coronary artery bypass grafting (CABG) surgery, 16 cases were isolated valve replacement, and two cases were valve replacement with CABG. The age range of the patients was between 6 and 78 years. The average time from the surgery was 49 ± 58 days which was longer than the usual bacterial mediastinitis. The overall mortality rate was 29%. CONCLUSION NTM sternal wound infection is rare but may be fatal if not properly treated. The toxic signs are often subtle and it will take longer to isolate compared to typical bacterial mediastinitis. Early recognition, the use of appropriate antibiotics based on susceptibility tests, and aggressive surgical debridement are required for full recovery.
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Affiliation(s)
- Shinya Unai
- Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Schweizer M, Perencevich E, McDanel J, Carson J, Formanek M, Hafner J, Braun B, Herwaldt L. Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: systematic review and meta-analysis. BMJ 2013; 346:f2743. [PMID: 23766464 PMCID: PMC3681273 DOI: 10.1136/bmj.f2743] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate studies assessing the effectiveness of a bundle of nasal decolonization and glycopeptide prophylaxis for preventing surgical site infections caused by Gram positive bacteria among patients undergoing cardiac operations or total joint replacement procedures. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed (1995 to 2011), the Cochrane database of systematic reviews, CINAHL, Embase, and clinicaltrials.gov were searched to identify relevant studies. Pertinent journals and conference abstracts were hand searched. Study authors were contacted if more data were needed. ELIGIBILITY CRITERIA Randomized controlled trials, quasi-experimental studies, and cohort studies that assessed nasal decolonization or glycopeptide prophylaxis, or both, for preventing Gram positive surgical site infections compared with standard care. PARTICIPANTS Patients undergoing cardiac operations or total joint replacement procedures. DATA EXTRACTION AND STUDY APPRAISAL: Two authors independently extracted data from each paper and a random effects model was used to obtain summary estimates. Risk of bias was assessed using the Downs and Black or the Cochrane scales. Heterogeneity was assessed using the Cochran Q and I(2) statistics. RESULTS 39 studies were included. Pooled effects of 17 studies showed that nasal decolonization had a significantly protective effect against surgical site infections associated with Staphylococcus aureus (pooled relative risk 0.39, 95% confidence interval 0.31 to 0.50) when all patients underwent decolonization (0.40, 0.29 to 0.55) and when only S aureus carriers underwent decolonization (0.36, 0.22 to 0.57). Pooled effects of 15 prophylaxis studies showed that glycopeptide prophylaxis was significantly protective against surgical site infections related to methicillin (meticillin) resistant S aureus (MRSA) compared with prophylaxis using β lactam antibiotics (0.40, 0.20 to 0.80), and a non-significant risk factor for methicillin susceptible S aureus infections (1.47, 0.91 to 2.38). Seven studies assessed a bundle including decolonization and glycopeptide prophylaxis for only patients colonized with MRSA and found a significantly protective effect against surgical site infections with Gram positive bacteria (0.41, 0.30 to 0.56). CONCLUSIONS Surgical programs that implement a bundled intervention including both nasal decolonization and glycopeptide prophylaxis for MRSA carriers may decrease rates of surgical site infections caused by S aureus or other Gram positive bacteria.
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Affiliation(s)
- Marin Schweizer
- University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Abstract
BACKGROUND Inspiratory muscle training (IMT) before cardiac surgery has proved to be a promising intervention to reduce postoperative pneumonia in a randomized controlled trial setting. Effects of IMT in routine care have not been reported. OBJECTIVE The purpose of this study was to investigate the effect of IMT before cardiac surgery on postoperative pneumonia in routine care at a Dutch university medical center using propensity scoring. DESIGN This was an observational cohort study. METHODS All candidates for cardiac surgery were preoperatively stratified by a physical therapist for low risk or high risk for postoperative pulmonary complications. Patients at high risk either engaged in an unsupervised IMT program (20 minutes a day) at home for at least 2 weeks before surgery (group 1) or received usual care (no IMT) (group 2). Results in terms of outcome measures were adjusted with propensity scores to reduce bias caused by nonrandom treatment assignment. RESULTS The results showed that of the 94 patients at high risk in group 1, 1 patient (1.1%) developed a postoperative pneumonia. In group 2, 8 out of the 252 patients at high risk (3.2%) developed this pulmonary complication (adjusted odds ratio=0.34, 95% confidence interval=0.04-3.38). No significant differences were found regarding median (25th-75th percentile) ventilation time (7 [5-9] hours versus 7 [5-10] hours), length of stay in the intensive care unit (23 [21-24] hours versus 23 [21-25] hours), or total postoperative length of stay (7 [6-11] days versus 7 [5-9] days). LIMITATIONS The most important limitations of this study were confounding, incomplete data collection, and a low incidence of the primary outcome. CONCLUSIONS Propensity scoring is believed to be a valuable tool of great potential interest to researchers in the field of observational studies. Whether IMT in routine care resulted in less postoperative pneumonia cannot be concluded.
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Serum concentrations and pharmacokinetics of moxifloxacin in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. Int J Antimicrob Agents 2013; 41:473-6. [DOI: 10.1016/j.ijantimicag.2013.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/28/2013] [Accepted: 01/31/2013] [Indexed: 12/12/2022]
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cove ME, Spelman DW, MacLaren G. Infectious complications of cardiac surgery: a clinical review. J Cardiothorac Vasc Anesth 2012; 26:1094-100. [PMID: 22765993 DOI: 10.1053/j.jvca.2012.04.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Indexed: 12/28/2022]
Affiliation(s)
- Matthew E Cove
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Kappeler R, Gillham M, Brown NM. Antibiotic prophylaxis for cardiac surgery. J Antimicrob Chemother 2011; 67:521-2. [PMID: 22186878 DOI: 10.1093/jac/dkr536] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Antibiotic prophylaxis for cardiac surgery is a controversial area. Recent systematic reviews and meta-analyses of randomized controlled trials have concluded that surgical site infection can be reduced by prolonging prophylaxis for 24-48 h. Also, post-operative pneumonia and all-cause mortality can be reduced by giving agents with both anti-Gram-negative and anti-Gram-positive activity. The choice of the most appropriate regimen remains open to debate.
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Affiliation(s)
- Ruth Kappeler
- Department of Microbiology, Papworth Hospital, Cambridge, UK.
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