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Lemmet T, Mazzucotelli JP, Collange O, Fath L, Mutter D, Brigand C, Falcoz PE, Danion F, Lefebvre N, Bourne-Watrin M, Gerber V, Hoellinger B, Fabacher T, Hansmann Y, Ruch Y. Infectious Mediastinitis: A Retrospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae225. [PMID: 38751899 PMCID: PMC11095524 DOI: 10.1093/ofid/ofae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Background This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection. Methods This retrospective observational study enrolled patients who had mediastinitis diagnosed according to the criteria defined by the Centers for Disease Control and Prevention and were treated in Strasbourg University Hospital, France, between 1 January 2010 and 31 December 2020. Results We investigated 151 cases, including 63 cases of poststernotomy mediastinitis (PSM), 60 cases of mediastinitis due to esophageal perforation (MEP) and 17 cases of descending necrotizing mediastinitis (DNM). The mean patient age (standard deviation) was 63 (14.5) years, and 109 of 151 patients were male. Microbiological documentation varied according to the origin of the infection. When documented, PSM cases were mostly monomicrobial (36 of 53 cases [67.9%]) and involved staphylococci (36 of 53 [67.9%]), whereas MEP and DNM cases were mostly plurimicrobial (38 of 48 [79.2%] and 8 of 12 [66.7%], respectively) and involved digestive or oral flora microorganisms, respectively. The median duration of anti-infective treatment was 41 days (interquartile range, 21-56 days), and 122 of 151 patients (80.8%) benefited from early surgical management. The overall 1-year survival rate was estimated to be 64.8% (95% confidence interval, 56.6%-74.3%), but varied from 80.1% for DNM to 61.5% for MEP. Conclusions Mediastinitis represents a rare yet deadly infection. The present cohort study exhibited the different patterns observed according to the origin of the infection. Greater insight and knowledge on these differences may help guide the management of these complex infections, especially with respect to empirical anti-infective treatments.
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Affiliation(s)
- Thomas Lemmet
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | | | - Olivier Collange
- Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France
| | - Léa Fath
- Department of E.N.T. and Head and Neck Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Didier Mutter
- Department of Visceral and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - François Danion
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Bourne-Watrin
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Victor Gerber
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Baptiste Hoellinger
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Thibaut Fabacher
- Department of biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Yvon Ruch
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
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McNeil T, Coats J, Daniel S, Gordon D. Candida spp. Deep Sternal Wound Infections: A Consequence of Antibiotic use? Open Forum Infect Dis 2024; 11:ofae157. [PMID: 38595953 PMCID: PMC11002952 DOI: 10.1093/ofid/ofae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 04/11/2024] Open
Abstract
A cluster of deep sternal wound infections caused by Candida spp. occurred at our institution. Investigation did not disclose a common environmental source. We postulate that broad-spectrum antibiotic surgical prophylaxis and liberal use of antibiotics contributed to these infections.
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Affiliation(s)
- Thomas McNeil
- Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Joanna Coats
- Infection Prevention and Control Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Santhosh Daniel
- Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Gordon
- Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Microbiology and Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia
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3
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Chen D, Zhang J, Wang Y, Jiang W, Xu Y, Xiong C, Feng Z, Han Y, Chen Y. Risk factors for sternal wound infection after open-heart operations: A systematic review and meta-analysis. Int Wound J 2024; 21:e14457. [PMID: 37909266 PMCID: PMC10898401 DOI: 10.1111/iwj.14457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
We aimed to quantitatively and systematically elucidate the rationality of the examined variables as independent risk factors for sternal wound infection. We searched databases to screen studies, ascertained the variables to be analysed, extracted the data and applied meta-analysis to each qualified variable. Odds ratios and mean differences were considered to be the effect sizes for binary and continuous variables, respectively. A random-effects model was used for these procedures. The source of heterogeneity was evaluated using a meta-regression. Publication bias was tested by funnel plot and Egger's test, the significant results of which were then calculated using trim and fill analysis. We used a sensitivity analysis and bubble chart to describe their robustness. After screening all variables in the eligible literature, we excluded 55 because only one or no research found them significant after multivariate analysis, leaving 33 variables for synthesis. Two binary variables (age over 65 years, NYHA class >2) and a continuous variable (preoperative stay) were not significant after the meta-analysis. The most robust independent risk factors in our study were diabetes mellitus, obesity, use of bilateral internal thoracic arteries, chronic obstructive pulmonary disease, prolonged surgery time, prolonged ventilation and critical preoperative state, followed by congestive heart failure, atrial fibrillation, renal insufficiency, stroke, peripheral vascular disease and use of an intra-aortic balloon pump. Relatively low-risk factors were emergent/urgent surgery, smoking, myocardial infarction, combined surgery and coronary artery bypass grafting. Sternal wound infection after open-heart surgery is a multifactorial disease. The detected risk factors significantly affected the wound healing process, but some were different in strength. Anything that affects wound healing and antibacterial ability, such as lack of oxygen, local haemodynamic disorders, malnutrition condition and compromised immune system will increase the risk, and this reminds us of comprehensive treatment during the perioperative period.
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Affiliation(s)
- Dongsheng Chen
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Jianghe Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Yuting Wang
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Weiqian Jiang
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Yujian Xu
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Chenlu Xiong
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Zekun Feng
- Department of Cardiovascular SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Yan Han
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Youbai Chen
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
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4
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Rustenbach CJ, Djordjevic I, Eghbalzadeh K, Baumbach H, Wendt S, Radwan M, Marinos SL, Mustafi M, Lescan M, Berger R, Salewski C, Sandoval Boburg R, Steger V, Nemeth A, Reichert S, Wahlers T, Schlensak C. Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes. Medicina (B Aires) 2022; 58:medicina58101415. [PMID: 36295575 PMCID: PMC9610783 DOI: 10.3390/medicina58101415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The strategy of revascularization may be constrained in patients with insufficient bypass grafts and with increased risk of wound healing disorders. Among those with complex left-sided double-vessel disease in whom a percutaneous coronary intervention (PCI), as well as the surgical procedure of minimally invasive coronary artery bypass grafting via left minithoracotomy (MICS CABG), is not a treatment option, CABG using the left internal mammary artery as a T-graft with itself may be an effective treatment strategy. Materials and Methods: We reviewed the data from patients treated in Cologne and Tuebingen from 2019 to 2022. We included 40 patients who received left internal mammary artery (LIMA) grafting, and additional T-graft with the LIMA itself. The objective was focused on intraoperative and short-term outcomes. Results: A total of 40 patients were treated with the LIMA-LIMA T-graft procedure with a Fowler score calculated at 20.1 ± 3.0. A total of 37.5% of all patients had lacking venous graft material due to prior vein stripping, and 21 patients presented severe vein varicosis. An overall of 2.6 ± 0.5 distal anastomoses (target vessels were left anterior descending, diagonal, intermediate branch, and/or left marginal ramus) were performed, partly sequentially. Mean flow of LIMA-Left anterior descending (LAD) anastomosis was 59.31 ± 11.04 mL/min with a mean PI of 1.21 ± 0.18. Mean flow of subsequent T-Graft accounted for 51.31 ± 3.81 mL/min with a mean PI of 1.39 ± 0.47. Median hospital stay was 6.2 (5.0; 7.5) days. No incidence of postoperative wound healing disorders was observed, and all patients were discharged. There was one 30-day readmission with a diagnosis of pericardial effusion (2.5%). There was no 30-day mortality within the cohort. Conclusions: Patients requiring surgical myocardial revascularization due to complex two-vessel coronary artery disease (CAD) can be easily managed with LIMA alone, despite an elevated Fowler score and a promising outcome. A prospective study needs to be conducted, as well as longer term surveillance, to substantiate and benchmark the long-term results, as well as the patency rates.
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Affiliation(s)
- Christian Jörg Rustenbach
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
| | | | - Stefanie Wendt
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
| | - Medhat Radwan
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
- Correspondence: ; Tel.: +49-7071-29-68492
| | - Spiro Lukas Marinos
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Rafal Berger
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Christoph Salewski
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Volker Steger
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Attila Nemeth
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Stefan Reichert
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
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Shi C, Zhang Z, Goldhammer J, Li D, Kiaii B, Rudriguez V, Boyd D, Lubarsky D, Applegate R, Liu H. Effect of lipid-lowering medications in patients with coronary artery bypass grafting surgery outcomes. BMC Anesthesiol 2022; 22:122. [PMID: 35473580 PMCID: PMC9040242 DOI: 10.1186/s12871-022-01675-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). METHODS After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups. RESULTS A total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P < 0.05). Propensity weighted risk-adjustment showed that lipid-lowering medication reduced in-hospital total complications (odds ratio (OR) = 0.856; 95% CI 0.781-0.938; P < 0.001); all neurologic complications (OR = 0.572; 95% CI 0.441-0.739; P < 0.001) including stroke (OR = 0.481; 95% CI 0.349-0.654; P < 0.001); in-hospital mortality (OR = 0.616; 95% CI 0.432-0.869; P = 0.006; P < 0.001); and overall mortality (OR = 0.723; 95% CI 0.634-0.824; P < 0.001). In addition, the results indicated postoperative lipid-lowering medication use was associated with improved long-term survival in this patient population. CONCLUSIONS Perioperative lipid-lowering medication use was associated with significantly reduced postoperative adverse events and improved overall outcome in elderly patients undergoing CABG surgery with CPB.
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Affiliation(s)
- Chunxia Shi
- Department of Anesthesiology, Peking University International Hospital, Beijing, China.,Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Zugui Zhang
- Institute for Research On Equality and Community Health, Christiana Care, Newark, DE, USA
| | - Jordan Goldhammer
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - David Li
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Bob Kiaii
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Victor Rudriguez
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Douglas Boyd
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - David Lubarsky
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Richard Applegate
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA.
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6
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Elsayed RS, N Carey J, Cohen RG, Barr ML, Baker CJ, Starnes VA, Bowdish ME. Early onset of deep sternal wound infection after cardiac surgery is associated with decreased survival: A propensity weighted analysis. J Card Surg 2021; 36:4509-4518. [PMID: 34570388 DOI: 10.1111/jocs.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare outcomes after the development of early (≤30 days) versus delayed (>30 days) deep sternal wound infection (DSWI) after cardiac surgery. METHODS Between 2005 and 2016, 64 patients were treated surgically for DSWI following cardiac surgery. Thirty-three developed early DSWI, while 31 developed late DSWI. The mean follow-up was 34.1 ± 32.3 months. RESULTS Survival for the entire cohort at 1, 3, and 5 years was 93.9%, 85.1%, and 80.8%, respectively. DSWI diagnosed early and attempted medical management was strongly associated with overall mortality (hazard ratio [HR], 25.0 and 9.9; 95% confidence intervals [CIs], 1.18-52.8 and 1.28-76.5; p-value .04 and .04, respectively). Survival was 88.1%, 77.0%, 70.6% and 100%, 94.0% and 94.0% at 1, 3, and 5 years in the early and late DSWI groups, respectively (log-rank = 0.074). Those diagnosed early were more likely to have a positive wound culture (odds ratio [OR], 0.06; 95% CI, 0.01-0.69; p = .024) and diagnosed late were more likely to be female (OR, 8.75; 95% CI, 2.0-38.4; p = .004) and require an urgent DSWI procedure (OR, 9.25; 95% CI, 1.86-45.9; p = .007). Both early diagnosis of DSWI and initial attempted medial management were strongly associated with mortality (HR, 7.48; 95% CI, 1.38-40.4; p = .019 and HR, 7.76; 95% CI, 1.67-35.9; p = .009, respectively). CONCLUSIONS Early aggressive surgical therapy for DSWI after cardiac surgery results in excellent outcomes. Those diagnosed with DSWI early and who have failed initial medical management have increased mortality.
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Affiliation(s)
- Ramsey S Elsayed
- Department of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Joseph N Carey
- Department of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Robbin G Cohen
- Department of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Mark L Barr
- Department of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Craig J Baker
- Department of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Vaughn A Starnes
- Department of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Michael E Bowdish
- Department of Cardiothoracic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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Rustenbach CJ, Djordjevic I, Gerfer S, Ivanov B, Gaisendrees C, Eghbalzadeh K, Wahlers T. Multiple Grafting with Single Left Internal Mammary Artery as T-Graft with Itself. Thorac Cardiovasc Surg 2021; 70:532-536. [PMID: 34521140 DOI: 10.1055/s-0041-1731758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Revascularization strategies might be limited in patients with lack of sufficient bypass graft material and increased risk of wound healing disturbances. In this regard, we present first results of patients treated with left internal mammary artery (LIMA) as T-graft with itself due to left-sided double-vessel disease, elevated risk of wound healing infection, and lack of graft material. METHODS Eighteen patients were retrospectively analyzed in this study. All patients received LIMA grafting, and additional T-graft with itself during off-pump coronary artery bypass surgery. The investigation was focused on intraoperative and postoperative outcomes. RESULTS LIMA-LIMA T-graft was performed in a total of 18 patients. Mean Fowler score accounted for 18.2 ± 2.9. Severe vein varicosis was present in 9 patients, and 38.9% of patients had lacking venous graft material due to prior vein stripping. A total of 2.5 ± 0.5 distal anastomoses were performed. Mean flow of LIMA-left anterior descending anastomosis was 41.72 ± 12.11 mL/min with a mean pulsatility index (PI) of 1.01 ± 0.21. Mean flow of subsequent T-graft accounted for 26.31 ± 4.22 mL/min with a mean PI of 1.59 ± 0.47. Median hospital stay was 7(6.75;8) days. No incidence of postoperative wound healing disorders was observed and all patients were discharged off hospital. CONCLUSIONS LIMA as T-graft with itself to treat left-sided double-vessel disease is feasible and safe in patients with missing bypass graft material and increased risk of deep sternal wound infection. Further prospective studies are necessary to confirm our results.
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Affiliation(s)
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | | | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany
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8
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Magro PL, Sousa Uva M. Does routine topical antimicrobial administration prevent sternal wound infection after cardiac surgery? Interact Cardiovasc Thorac Surg 2021; 32:452-456. [PMID: 33346346 DOI: 10.1093/icvts/ivaa292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/19/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Does routine topical antimicrobial administration prevent sternal wound infection (SWI) after cardiac surgery? Altogether >238 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several different antimicrobial agents, dosages and application protocols were found in the literature. Regarding topical vancomycin use, a meta-analysis by Kowalewski et al. demonstrated a 76% risk reduction in any SWI. Collagen-gentamicin sponge application was associated with a 38% risk reduction in SWI in another meta-analysis by Kowalewski et al., which included 4 randomized control trials and >23 000 patients. Lower evidence observational studies found benefit in the use of different regimes, including: combination of vancomycin paste and subcutaneous gentamycin; combined cefazoline and gentamicin spray; isolated cefazolin; bacitracin ointment; and rifampicin irrigation. We conclude that, in light of the body of evidence available, topical antibiotic application prevents SWI, including both superficial and deep SWI. The strongest evidence, derived from 2 meta-analyses, is related to the use of gentamicin-collagen sponges and topical vancomycin. Heterogeneity throughout studies regarding antibiotic agents, dosages, application protocols and SWI definition makes providing general recommendations challenging.
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Affiliation(s)
- Pedro Lamares Magro
- Department of Cardio-thoracic Surgery, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Miguel Sousa Uva
- Department of Cardio-thoracic Surgery, Hospital de Santa Cruz, Carnaxide, Portugal
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9
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Engineering of cerium oxide loaded chitosan/polycaprolactone hydrogels for wound healing management in model of cardiovascular surgery. Process Biochem 2021. [DOI: 10.1016/j.procbio.2021.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Brunet A, N'Guyen Y, Lefebvre A, Poncet A, Robbins A, Bajolet O, Saade Y, Ruggieri VG, Rubin S. Obesity and Preoperative Anaemia as Independent Risk Factors for Sternal Wound Infection After Coronary Artery Bypass Graft Surgery with Pedicled (Non-Skeletonized) Internal Mammary Arteries: The Role of Thoracic Wall Ischemia? Vasc Health Risk Manag 2020; 16:553-559. [PMID: 33364774 PMCID: PMC7751291 DOI: 10.2147/vhrm.s264415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/19/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Obesity remains statistically associated with coronary artery disease, for which coronary artery bypass graft surgery (CABG) remains the standard of care. However, obesity is also associated with sternal wound infection (SWI) which is a severe complication of CABG despite advances in surgery and in infection prevention and control. Strategies to reduce the incidence of SWI are still being investigated, and we therefore conducted a retrospective study to revisit factors other than obesity associated with SWI after CABG. Patients and Methods Data were extracted from the medical records of 182 patients who underwent elective on-pump CABG using one or both pedicled internal mammary artery grafts in Reims University Hospital between May 2015 and May 2016. All preoperative or perioperative variables with a p value<0.10 in univariate analysis were entered into a stepwise logistic regression model. Results Among the 182 patients (145 male (79.6%), median age 68.0 [45.0-87.0] years), 138 (75.8%) underwent CABG using bilateral internal mammary artery grafts. Median BMI was 27.7 [18.7-50.5] kg/m2, and there were 51 (28.0%) and 79 (43.4%) patients with obesity and overweight, respectively. Twenty-three out of the 182 patients (12.6%) developed SWI. In-hospital mortality was not statistically different between patients with and without SWI but the median length of stay was (6.0 [2.0-38.0] versus 5.0[3.0-21.0] days in the intensive care unit, p=0.03, and 26.0 [9.0-134.0] versus 9.0 [7.0-51.0] days in hospital, p<0.0001). Obesity and preoperative anaemia were independently associated with SWI, as was the number of red blood cell (RBC) units transfused (OR 14.61 [2.64-80.75], OR 4.64 [1.61-13.34] and OR 1.27 [1.02-1.58], respectively). Conclusion The independent association of SWI with the number of RBC units transfused and the existence of preoperative anaemia and obesity suggests a mechanism of thoracic wall ischemia in SWI after CABG, thus leaving insufficient perfusion of the thoracic wall in patients with obesity. Medical strategies are warranted to try to prevent this costly complication.
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Affiliation(s)
- Aurélie Brunet
- Internal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Reims, France
| | - Yohan N'Guyen
- Internal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Reims, France
| | - Annick Lefebvre
- Operational Hygiene Team, Robert Debré University Hospital, Reims, France
| | - Anne Poncet
- Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France
| | - Ailsa Robbins
- Internal Medicine, Infectious Diseases and Clinical Immunology, Robert Debré University Hospital, Reims, France
| | - Odile Bajolet
- Operational Hygiene Team, Robert Debré University Hospital, Reims, France
| | - Yves Saade
- Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France
| | | | - Sylvain Rubin
- Thoracic and Cardiovascular Surgery, Robert Debré University Hospital, Reims, France
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