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Fiocco A, Dini M, Lorenzoni G, Gregori D, Colli A, Besola L. The prophylactic use of negative-pressure wound therapy after cardiac surgery: a meta-analysis. J Hosp Infect 2024; 148:95-104. [PMID: 38677481 DOI: 10.1016/j.jhin.2024.04.003] [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: 10/30/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
Surgical site infections (SSIs) pose a frequent complication in cardiac surgery patients and lead to increased patient discomfort and extended hospitalization. This meta-analysis aimed to evaluate the protective role of single-use negative-pressure wound therapy (sNPWT) devices on closed surgical wounds after cardiac surgery, and explored their potential preventive application across all cardiac surgery patients. A comprehensive literature search was conducted on ScienceDirect, focusing on studies related to "negative pressure wound therapy" or "PICO negative pressure wound therapy" combined with "cardiac surgery" or "sternotomy," published between 2000 and 2022. Inclusion criteria encompassed case-control studies comparing sNPWT with traditional dressings on closed cardiac surgical incisions in adult patients undergoing median sternotomy without immediate postoperative infective complications, with available details on SSIs. A retrospective analysis of cases treated with sNPWT in our centre was also performed. The meta-analysis revealed a protective role of sNPWT, indicating a 44% risk reduction in overall SSIs (odds ratio 0.56) and a 40% risk reduction in deep wound infections (odds ratio 0.60). Superficial wound infections, however, showed non-significant protective effects. A single-centre study aligned with the meta-analysis findings, confirming the efficacy of sNPWT and was included in the meta-analysis. In conclusion, the meta-analysis and the single-centre study collectively support the protective role of negative pressure wound therapy against overall and deep SSIs, suggesting its potential prophylactic use on all cardiac surgery populations.
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Affiliation(s)
- A Fiocco
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - M Dini
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - G Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - D Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - A Colli
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
| | - L Besola
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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2
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Unosson H, Nyman MH, Brynhildsen KF, Friberg Ö. Risk factors for infection at the saphenous vein harvest site after coronary artery bypass grafting surgery: a retrospective cohort study. J Cardiothorac Surg 2024; 19:310. [PMID: 38822404 PMCID: PMC11141009 DOI: 10.1186/s13019-024-02799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Surgical site infection after saphenous vein harvest is common, with reported leg wound infection rates ranging from 2 to 24%. There have been few investigations into sex-related differences in complication rates. Moreover, varied effects of smoking have been reported. The aim of this study was to investigate risk factors such as gender and smoking, associated with surgical site infection after vein graft harvesting in coronary artery bypass grafting surgery. METHODS We included 2,188 consecutive patients who underwent coronary artery bypass grafting surgery with at least one vein graft at our centre from 2009 to 2018. All patients were followed up postoperatively. Risk factors for leg wound infection requiring antibiotic treatment and surgical revision were analysed using logistic regression analysis. RESULTS In total, 374 patients (17.1%) received antibiotic treatment and 154 (7.0%) underwent surgical revision for leg wound infection at the harvest site. Female sex, high body mass index, diabetes mellitus, longer operation time, peripheral vascular disease and direct oral anticoagulants were independently associated with any leg wound infection at the harvest site. Among surgically revised patients, female sex and insulin or oral treatment for diabetes mellitus as well as longer operation time were independent risk factors. Smoking was not associated with leg wound infection. CONCLUSION Female sex is associated with increased risk of leg wound infection. The underlying mechanism is unknown. In the current population, previous or current smoking was not associated with an increased risk of leg wound infection.
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Affiliation(s)
- Hanna Unosson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Karin Falk Brynhildsen
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Jiang X, Xu Y, Li M, Jiao G, Rong X, Bu F. Antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management for sternal infection after midline sternotomy. J Cardiothorac Surg 2024; 19:289. [PMID: 38745239 PMCID: PMC11092104 DOI: 10.1186/s13019-024-02749-0] [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: 12/18/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Deep sternal wound infection (DSWI) after midline sternotomy of cardiac surgery is a challenging complication that affects the outcome of surgery. This study aims to assess the clinical effectiveness of the antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management in the treatment of DSWI. METHODS We retrospectively analyzed 5 patients with DSWI who underwent antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps for chest wall reconstruction after sternotomy for cardiac surgery in a tertiary hospital in China from January 2020 to December 2021. The clinical and follow-up data were retrospectively analyzed. RESULTS All patients had no perioperative mortalities, no postoperative complications, 100% wound healing, and an average hospital stay length of 24 days. The follow-up periods were from 6 to 35 months (mean 19.6 months). None of the cases showed wound problems after initial reconstruction using antibiotic-loaded bone cement combined with bilateral pectoralis major muscle flaps. CONCLUSIONS We report our successful treatment of DSWI, using antibiotic-loaded bone cement fixation technique combined with bilateral pectoralis major muscle flaps tension-free management. The clinical and follow-up results are favorable.
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Affiliation(s)
- Xia Jiang
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Yong Xu
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Mingqiu Li
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Guoqing Jiao
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China
| | - Xiaosong Rong
- Department of Cardiovascular Surgery, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, No.299 Qingyang Road, Wuxi, Jiang Su Province, 214203, China.
| | - Fanyu Bu
- Department of Chronic Wound, Wuxi Ninth People's Hospital affiliated to Soochow University, No.999 Liangqing Road, Wuxi, Jiang su Province, 214062, China.
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Li H, Zheng X, Gao J. Extensive analysis of risk factors associated with surgical site infections post-cardiothoracic open surgery. Int Wound J 2024; 21:e14842. [PMID: 38484717 PMCID: PMC10940006 DOI: 10.1111/iwj.14842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
Surgical site infections (SSIs) post-cardiothoracic surgery represent a significant challenge in patient care. Understanding the risk factors contributing to SSIs is essential for improving surgical outcomes and patient safety. A comprehensive retrospective analysis was conducted at our institution from January 2021 to December 2022. This study included 30 patients with SSIs and 60 without, following cardiothoracic open surgery. Data were collected on various variables, including hypertension, anaemia, operation time, hospital stay, alcohol consumption, smoking habits, Body Mass Index, age, and drainage tube placement. Univariate and multivariate logistic regression analyses were employed using SPSS software to identify significant predictors of SSIs. Univariate analysis indicated a strong correlation between SSIs and factors like smoking, diabetes mellitus, drainage tube placement, anaemia, and significant intraoperative blood loss (≥800 mL). These factors were statistically significant with p-values < 0.05. Multivariate logistic regression further confirmed the impact of these factors, with high odds ratios indicating a substantial increase in SSI risk associated with these conditions. This study highlights intraoperative blood loss, anaemia, drainage tube placement, smoking, and diabetes mellitus as key risk factors for SSIs post-cardiothoracic surgery. Recognising and addressing these factors through targeted preventive measures is crucial in clinical practice to reduce the incidence of SSIs and improve postoperative care in cardiothoracic surgery.
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Affiliation(s)
- Hong Li
- Cardio‐Thoracic Surgery DepartmentQionghai People's HospitalQionghaiChina
| | - Xufeng Zheng
- Cardio‐Thoracic Surgery DepartmentQionghai People's HospitalQionghaiChina
| | - Jie Gao
- Gynecology‐Breast and Thyroid Surgery DepartmentQionghai People's HospitalQionghaiChina
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Unbehaun P, Prantl L, Langer S, Spindler N. Antibiotic therapy in reconstructive surgery of deep sternal wound infections. Clin Hemorheol Microcirc 2024; 86:183-194. [PMID: 38007643 DOI: 10.3233/ch-238121] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND The choice of antibiotics and length of administration in the treatment of deep sternal wound infections (DSWI) is unclear. The reason for this is the lack of studies and local differences in resistance. An increase in resistance can be observed in gram-positive cocci, which are the most frequently detected in deep sternal infections. The duration of administration is often 2- 6 weeks or longer, although the benefit of prolonged antibiotic administration has not been confirmed by studies. We evaluated the antibiotic treatment during surgical treatment, consisting of surgical wound debridement and plastic chest reconstruction. METHODS Retrospective analysis of patients (n = 260) who underwent reconstructive surgery in the Department of Plastic Surgery at Leipzig University Hospital from 01.05.2012 - 31.12.2020. The duration of intake, results of microbiological swabs and resistance were investigated. RESULTS At the time of discharge, closed wound conditions were noted in 177 of 260 cases (68.1%). The largest proportion of patients (n = 238) was treated with a latissimus dorsi flap (91.5%).Antibiotic treatment was conducted in 206 of 260 cases (79.2%). The mean duration of antibiotic administration was 21.4 days (±17.6). Prolonged treatment over 14 days did not alter outcome (p = 0.226), in contrast, the number of multidrug resistances (p < 0.001). There was no prove of resistance against linezolid which is effective against the most common found infectious agents Staphylococcus epidermidis (n = 93; 24.0 %) & Staphylococcus aureus (n = 47; 12.1 %). CONCLUSION There is no evidence of benefit from antibiotic therapy over 14 days, whereas multidrug resistance increases with prolonged antibiotic use. In the absence of infectious agents or clinical signs of inflammation, surgical treatment without additional antibiotic treatment is effective.Linezolid is a suitable antibiotic in the treatment of gram-positive infections which are the most frequent in DSWI.
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Affiliation(s)
- P Unbehaun
- Department of Plastic, Hand and Reconstructive Surgery, Universitätsklinikum Regensburg, Regensburg, Germany
| | - L Prantl
- Universitätsklinikum Regensburg, Regensburg, Germany
| | - S Langer
- Universitätsklinikum Leipzig, Leipzig, Germany
| | - N Spindler
- Varisano Krankenhaus Bad Soden, Bad Soden, Germany
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Tao Y, Zhang Y, Liu Y, Tang S. Effects of negative pressure wound therapy on surgical site wound infections after cardiac surgery: A meta-analysis. Int Wound J 2023; 21:e14398. [PMID: 37740679 PMCID: PMC10824598 DOI: 10.1111/iwj.14398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023] Open
Abstract
We conducted a comprehensive analysis to evaluate the benefits of negative pressure wound therapy (NPWT) versus traditional dressings in preventing surgical site infections in patients undergoing cardiac surgery. We thoroughly examined several databases, including PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, Chinese Biomedical Literature Database (CBM) and Wanfang, from inception until July 2023. Two independent researchers were responsible for the literature screening, data extraction and quality assessment; analyses were performed using RevMan 5.4 software. Thirteen studies comprising 8495 patients were deemed relevant. A total of 2685 patients were treated with NPWT, whereas 5810 received conventional dressings. The findings revealed that NPWT was more effective in reducing surgical site infections after cardiac surgery than conventional dressings (4.88% vs. 5.87%, odds ratio [OR]: 0.50, 95% confidence intervals [CIs]: 0.40-0.63, p < 0.001). Additionally, NPWT was more effective in reducing deep wound infections (1.48% vs. 4.15%, OR: 0.36, 95% CI: 0.23-0.56, p < 0.001) and resulted in shorter hospital stays (SMD: -0.33, 95% CIs: -0.54 to -0.13, p = 0.001). However, the rate of superficial wound infections was not significantly affected by the method of wound care (3.72% vs. 5.51%, OR: 0.63, 95% CI: 0.32-1.23, p = 0.180). In conclusion, NPWT was shown to be advantageous in preventing postoperative infections and reducing hospital stay durations in patients undergoing cardiac surgery. Nonetheless, given the limitations in the number and quality of the included studies, further research is recommended to validate these findings.
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Affiliation(s)
- Yixi Tao
- Department of Cardiovascular MedicineThe First Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Yusui Zhang
- Interventional Surgery of RadiologyThe First Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Yang Liu
- Department of Scientific Research DivisionThe First Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
| | - Songjiang Tang
- Department of AnaesthesiaThe First Affiliated Hospital of Guizhou University of Traditional Chinese MedicineGuiyangChina
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Schmidt T, Malik A, Pislaru S, Sinak L. Don't Tear My Heart: Sternal Wire Pericardial Injury After Aortic Valve Replacement. CASE (PHILADELPHIA, PA.) 2023; 7:278-282. [PMID: 37546360 PMCID: PMC10403635 DOI: 10.1016/j.case.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
•TTE is a valuable cardiac imaging tool given its availability. •TTE can be used for the evaluation of cardiothoracic surgical complications. •Imaging modalities aid in supplementing information in postoperative patients. •Sternal wire fracture may cause a cardiac laceration.
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Affiliation(s)
- Tyler Schmidt
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Awais Malik
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Sorin Pislaru
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Lawrence Sinak
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
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Bota O, Pablik J, Taqatqeh F, Mülhausen M, Matschke K, Dragu A, Rasche S, Bienger K. Pathological study of sternal osteomyelitis after median thoracotomy-a prospective cohort study. Langenbecks Arch Surg 2023; 408:188. [PMID: 37165212 PMCID: PMC10172283 DOI: 10.1007/s00423-023-02926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Osteomyelitis of the sternum may arise either as a primary condition or secondary to median thoracotomy after cardiac surgery, with the latter being decidedly more frequent. Deep sternal wound infections appear as a complication of median thoracotomy in 0.2 to 4.4% of cases and may encompass the infection of the sternal bone. To date, there are no exhaustive histopathological studies of the sternal osteomyelitis. METHODS Our work group developed a surgical technique to remove the complete infected sternal bone in deep sternal wound infections. We therefore prospectively examined the en bloc resected sternal specimens. Seven standard histological sections were made from the two hemisternums. RESULTS Forty-seven sternums could be investigated. The median age of the patients in the cohort was 66 (45-81) years and there were 10 females and 37 males. Two methods were developed to examine the histological findings, with one model dividing the results in inflammatory and non-inflammatory, while the second method using a score from 0 to 5 to describe more precisely the intensity of the bone inflammation. The results showed the presence of inflammation in 76.6 to 93.6% of the specimens, depending on the section. The left manubrial sections were more prone to inflammation, especially when the left mammary artery was harvested. No further risk factors proved to have a statistical significance. CONCLUSION Our study proved that the deep sternal wound infection may cause a ubiquitous inflammation of the sternal bone. The harvest of the left mammary artery may worsen the extent and intensity of infection.
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Affiliation(s)
- Olimpiu Bota
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Jessica Pablik
- Institute for Pathology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Feras Taqatqeh
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Maxime Mülhausen
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Heart Center, TU Dresden, Dresden, Germany
| | - Adrian Dragu
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Stefan Rasche
- Surgical Intensive Care Unit, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Kevin Bienger
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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9
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Arribas-Leal JM, Rivera-Caravaca JM, Hernández-Torres A, Jiménez-Aceituna A, Moral-Escudero E, Pérez-Andreu J, García-Vázquez E, Gutiérrez-García F, García-Puente JJ, Marín F, Cánovas-López SJ, Herrero-Martínez JA. Incidence and predictors of sternal surgical wound infection in cardiac surgery: A prospective study. Int Wound J 2023; 20:917-924. [PMID: 36168924 PMCID: PMC10031248 DOI: 10.1111/iwj.13938] [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: 05/12/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Sternal surgical wound infection (SSWI) in cardiac surgery is associated with increased morbidity. We investigated the incidence of SSWI, the main germs implicated and predictors of SSWI. Prospective study including patients undergoing full median sternotomy between January 2017 and December 2019. Patients were followed-up for 3 months after hospital discharge. All sternal wound infections up to 90 days after discharge were considered SSWI. 1004 patients were included. During follow-up, 68 (6.8%) patients presented SSWI. Patients with SSWI had a higher incidence of postoperative renal failure (29.4% vs 17.1%, P = .007), a higher incidence of early postoperative reoperation for non-infectious causes (42.6% vs 9.1%, P < .001), longer ICU stay (3 [2-9] days vs 2 [2-4] days, P = .006), and longer hospital stay (24.5 [14.8-38.3] days vs 10 [7-18] days, P < .001). Gram-positive germs were presented in 49% of the cultures, and gram-negative bacteria in 35%. Early reoperation for non-infectious causes (OR 4.90, 95% CI 1.03-23.7), and a longer ICU stay (OR 1.37 95% CI 1.10-1.72) were independent predictors of SSWI. SSWI is rare but leads to more postoperative complications. The need for early reoperation because of non-infectious cause and a longer ICU stay were independently associated with SSWI.
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Affiliation(s)
- José María Arribas-Leal
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Alicia Hernández-Torres
- Deparment of Infectious Diseases and Internal Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Antonio Jiménez-Aceituna
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Encarnación Moral-Escudero
- Deparment of Infectious Diseases and Internal Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Joaquín Pérez-Andreu
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Elisa García-Vázquez
- Deparment of Infectious Diseases and Internal Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Francisco Gutiérrez-García
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Julio J García-Puente
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Sergio J Cánovas-López
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - José Antonio Herrero-Martínez
- Deparment of Infectious Diseases and Internal Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
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10
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Sandström N, Söderquist B, Wistrand C, Friberg Ö. The presence of skin bacteria in the sternal wound and contamination of implantation materials during cardiac surgery. J Hosp Infect 2023; 135:145-151. [PMID: 37004786 DOI: 10.1016/j.jhin.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Sternal wound infections (SWI) and aortic graft infections (AGI) are serious complications after cardiac surgery. Staphylococcus aureus and coagulase-negative staphylococci are the most common causes of SWI, while AGI are less studied. AGI may occur from contamination during surgery or postoperative haematogenous spread. Skin commensals, such as Cutibacterium acnes, are present in the surgical wound; however, their ability to cause infection is debated. AIM The aim of this study was to investigate the presence of skin bacteria in the sternal wound and to evaluate their possible ability to contaminate surgical materials. METHODS We included 50 patients that underwent coronary artery bypass graft surgery and/or valve replacement surgery at our centre from 2020 to 2021. Cultures were collected from skin and subcutaneous tissue at two time points during surgery, and from pieces of vascular graft and felt that were pressed against subcutaneous tissue. The most common bacterial isolates were tested for antibiotic susceptibility with disk diffusion and gradient tests. FINDINGS Cultures from skin had bacterial growth in 48% of patients at surgery start and in 78% after two hours, and cultures from subcutaneous tissue were positive in 72% and 76% of patients, respectively. The most common isolates were C. acnes and S. epidermidis. Cultures from surgical materials were positive in 80-88%. No difference in susceptibility was found for S. epidermidis isolates at surgery start compared to after two hours. CONCLUSIONS The results suggest that skin bacteria are present in the wound and may contaminate surgical graft material during cardiac surgery.
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Affiliation(s)
- N Sandström
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - B Söderquist
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Laboratory Medicine, Clinical Microbiology, and Infectious Diseases, Örebro University Hospital, Örebro, Sweden
| | - C Wistrand
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ö Friberg
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
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11
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Zhou Y, Xia T, Du M, Cao H, Zheng Q, Yang J, Yan Z. The strategy to track and combat the deep sternal wound infection caused by Mycobacterium farcinogenes. J Hosp Infect 2023:S0195-6701(23)00102-0. [PMID: 37001604 DOI: 10.1016/j.jhin.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Y Zhou
- Department of Laboratory Medicine, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - T Xia
- Department of Disease Prevention and Control, Hainan Hospital of PLA General Hospital, Sanya, Hainan, People's Republic of China
| | - M Du
- Department of Disease Prevention and Control, First Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - H Cao
- Department of Laboratory Medicine, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - Q Zheng
- Department of Laboratory Medicine, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China
| | - J Yang
- Department of Disease Prevention and Control, Hainan Hospital of PLA General Hospital, Sanya, Hainan, People's Republic of China
| | - Z Yan
- Department of Disease Prevention and Control, Hainan Hospital of PLA General Hospital, Sanya, Hainan, People's Republic of China; Department of Disease Prevention and Control, Second Medical Centre of PLA General Hospital, Beijing, People's Republic of China.
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12
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Xue L, Ding Y, Qin Q, Liu L, Ding X, Zhou Y, Liu K, Singla RK, Shen K, Din AU, Zhang Y, Shen Z, Shen B, Miao L. Assessment of the impact of intravenous antibiotics treatment on gut microbiota in patients: Clinical data from pre-and post-cardiac surgery. Front Cell Infect Microbiol 2023; 12:1043971. [PMID: 36741975 PMCID: PMC9896080 DOI: 10.3389/fcimb.2022.1043971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023] Open
Abstract
Background and aims Surgical site infection is a common complication after surgery. Periprocedural antibiotics are necessary to prescribe for preventing or treating infections. The present study aimed to explore the effect of intravenous antibiotics on gut microbiota and menaquinone biosynthesis in patients, especially in elderly patients undergoing cardiac surgery. Methods A total of 388 fecal samples were collected from 154 cardiac surgery patients. The V3-V4 hypervariable region of the bacterial 16S rRNA gene was amplified and sequenced on a MiSeq PE300. The gut microbiota diversity of samples was analyzed in terms of α- and β-diversity at the OTU level. The different groups were classified according to antibiotics in combinations and single antibiotics. PICRUSt2 was used for preliminary prediction of the gut microbiota function for menaquinone biosynthesis. Results The intravenously administered antibiotics which are excreted via bile represents the main antibiotics that could disturb the gut microbiota's composition in cardiac surgery patients, especially for elderly patients. The effect of antibiotics on gut microbiota is produced after antibiotics treatments over one week. The recovery of gut microbiota to the state of pre-antibiotics may require over two weeks of antibiotics withdrawal. Sex factor doesn't represent as an influencer in gut microbiota composition. Long-term use of cefoperazone-sulbactam may affect coagulation function. Conclusions The composition of the gut microbiota had a significant change post-intravenous antibiotics treatment in cardiac surgery patients. The richness and diversity of gut microbiota are increased in elderly patients.
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Affiliation(s)
- Ling Xue
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China,Department of Pharmacology, Faculty of Medicine, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Yinglong Ding
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiong Qin
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linsheng Liu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoliang Ding
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Zhou
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Kun Liu
- Reproductive Medicine Centre, The First Hospital of Lanzhou University, Lanzhou, China
| | - Rajeev K. Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China,School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Ke Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Ahmad Ud Din
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zhang
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhenya Shen
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Soochow University, Suzhou, China,*Correspondence: Liyan Miao, ; Bairong Shen, ; Zhenya Shen,
| | - Bairong Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Liyan Miao, ; Bairong Shen, ; Zhenya Shen,
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China,National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China,Institute for Interdisciplinary Drug Research and Translational Sciences, Soochow University, Suzhou, China,*Correspondence: Liyan Miao, ; Bairong Shen, ; Zhenya Shen,
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13
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Kaspersen AE, Nielsen SJ, Orrason AW, Petursdottir A, Sigurdsson MI, Jeppsson A, Gudbjartsson T. Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART. Eur J Cardiothorac Surg 2021; 60:233-241. [PMID: 33623983 DOI: 10.1093/ejcts/ezab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Deep sternal wound infection (DSWI) is a serious complication after open-heart surgery. We investigated the association between DSWI and short- and long-term all-cause mortality in a large well-defined nationwide population. METHODS A retrospective, nationwide cohort study, which included 114676 consecutive patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery from 1997 to 2015 in Sweden. Short- and long-term mortality was compared between DSWI patients and non-DSWI patients using propensity score inverse probability weighting adjustment based on patient characteristics and comorbidities. Median follow-up was 8.0 years (range 0-18.9). RESULTS Altogether, 1516 patients (1.3%) developed DSWI, most commonly in patients undergoing combined CABG and valve surgery (2.1%). DSWI patients were older and had more disease burden than non-DSWI patients. The unadjusted cumulative mortality was higher in the DSWI group compared with the non-DSWI group at 90 days (7.9% vs 3.0%, P < 0.001) and at 1 year (12.8% vs 4.5%, P < 0.001). The adjusted absolute difference in risk of death was 2.3% [95% confidence interval (CI): 0.8-3.9] at 90 days and 4.7% (95% CI: 2.6-6.7) at 1 year. DSWI was independently associated with 90-day [adjusted relative risk (aRR) 1.89 (95% CI: 1.38-2.59)], 1-year [aRR 2.13 (95% CI: 1.68-2.71)] and long-term all-cause mortality [adjusted hazard ratio 1.56 (95% CI: 1.30-1.88)]. CONCLUSIONS Both short- and long-term mortality risks are higher in DSWI patients compared to non-DSWI patients. These results stress the importance of preventing these infections and careful postoperative monitoring of DSWI patients.
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Affiliation(s)
- Alexander Emil Kaspersen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne J Nielsen
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | | | - Astridur Petursdottir
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - Martin Ingi Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Anaesthesia and Intensive Care, Landspitali University Hospital, Reykjavik, Iceland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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14
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Myllykangas HM, Halonen J, Husso A, Berg LT. Decreasing complications of pectoralis major muscle flap reconstruction with two modalities of negative pressure wound therapy. Scand J Surg 2021; 111:14574969211043330. [PMID: 34486448 DOI: 10.1177/14574969211043330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Deep sternal wound infection is a feared complication of open-heart surgery. Negative pressure wound therapy has gained an important role in the treatment of deep sternal wound infection. Incisional negative pressure wound therapy has been introduced as a method to prevent wound complications after sternotomy, and lately, after flap reconstructions in the treatment of deep sternal wound infection. We aimed to study if incisional negative pressure wound therapy with PICO™ had similar beneficial effect described earlier with competing commercial devices. METHODS This study included 82 patients treated with pectoralis major muscle flap for deep sternal wound infection during the years 2006-2020. PICO group consisted of 24 patients treated with preoperative negative pressure wound therapy and postoperative incisional negative pressure wound therapy (PICO™). Two control groups included 48 patients with conventional treatment and 10 patients with preoperative negative pressure wound therapy only. RESULTS In the PICO group, the complication rate declined from 50.0% to 33.30%, major complication rate from 29.2% to 12.5%, and need for an additional flap from 14.6.% to 4.2% when compared to conventional treatment. The length of hospital stay decreased as well. Preoperative negative pressure wound therapy alone was associated with moderate decline in the complication rates. In addition, we described the use of split pectoralis major muscle flap reconstruction in 57 patients. To our knowledge, this is the largest published patient series describing this method in the treatment of deep sternal wound infection. CONCLUSIONS Incisional negative pressure wound therapy with PICO™ seems beneficial after flap reconstruction. Split pectoralis major muscle flap is a versatile reconstruction option suitable to be used as a workhorse in the treatment of deep sternal wound infection.
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Affiliation(s)
- Heidi-Mari Myllykangas
- Department of Plastic Surgery, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland
| | - Jari Halonen
- University of Eastern Finland, Kuopio, Finland Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Annastiina Husso
- Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Leena T Berg
- Department of Plastic Surgery, Kainuu Central Hospital, Kajaani, Finland
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15
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Brega C, Calvi S, Albertini A. Use of a negative pressure wound therapy system over closed incisions option in preventing post-sternotomy wound complications. Wound Repair Regen 2021; 29:848-852. [PMID: 33780088 DOI: 10.1111/wrr.12914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Post-sternotomy surgical site infections may be serious complications responsible for increased morbidity, mortality and length of hospital stay. A variety of wound-healing strategies can be used over closed surgical incisions, including negative pressure wound therapy (NPWT). The aim of the study is to assess sternal wound complications after heart surgery using NPWT in patients at risk for surgical site complication. Considered risk factors affecting wound healing were type 2 diabetes, Body Mass Index (BMI) >30, chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF) and myocardial revascularization by double mammary artery harvesting. With these premises, 90 patients were selected: 30 patients received traditional gauze dressings, 30 advanced dressings (hydrocolloid and carboxymethyl cellulose) and 30 patients NPWT. Thirty-four patients (37.7%) had two risk factors, 41 patients (45.5%) were affected by three risk factors and 15 patients (16.6%) by four risk factors. The NPWT group had lower rates of diabetes and CRF and only one patient presented four risk factors. With regard to surgical times and types of surgical procedure, no significant differences were observed within the three groups. The patients who received NPWT over closed incision experimented a significantly lower rate of deep sternal complication over traditional gauze and hydrocolloid and carboxymethyl cellulose dressings.
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Affiliation(s)
- Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Simone Calvi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Alberto Albertini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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16
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Wyckman A, Abdelrahman I, Steinvall I, Zdolsek J, Granfeldt H, Sjöberg F, Nettelblad H, Elmasry M. Reconstruction of sternal defects after sternotomy with postoperative osteomyelitis, using a unilateral pectoralis major advancement muscle flap. Sci Rep 2020; 10:8380. [PMID: 32433505 PMCID: PMC7239941 DOI: 10.1038/s41598-020-65398-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background: The pectoralis major flap, which is usually harvested bilaterally, is considered a workhorse flap in the reconstruction of sternal defects. After a median sternotomy for open heart surgery, 1%-3% of patients develop deep infection and dehiscence of the sternal wound, some of which will eventually require reconstructive surgery. Our aim was to describe the clinical feasibility and associated complications of the unilateral pectoralis major advancement flap in the reconstruction of sternal defects. Methods: A retrospective analysis of all adult patients who were operated on using a unilateral pectoralis major flap for reconstruction of the chest wall at the Linköping University Hospital during 2008–18 was made using data retrieved from medical records. Results: Forty-three patients had reconstructions with unilateral pectoralis major flaps. Three flaps failed completely, and another 10 patients developed complications that required further operation. The factors that were independently associated with loss of the flaps and complications were: older age, male sex, the number of different antibiotics used, and a long duration of treatment with negative wound pressure. Fewer wound revisions before the reconstruction resulted in more complications. The factors that were independently associated with prolonged time to complete healing were emergency reoperation after the initial operation and complications after reconstruction. Conclusion: The unilateral pectoralis major advancement flap has proved to be a useful technique in the reconstruction of most sternal defects after sternal wound infection in older patients. There is, however, need for a follow-up study on a larger number of procedures to evaluate the long-term outcome compared with other methods of sternal reconstruction.
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Affiliation(s)
- Alexander Wyckman
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Islam Abdelrahman
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johann Zdolsek
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hans Granfeldt
- Department of Thoracic and Vascular Surgery in Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hans Nettelblad
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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17
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Liu S, Zhang J, Yin H, Pang L, Wu B, Shi H. The value of
18
F‐FDG PET
/
CT
in diagnosing and localising deep sternal wound infection to guide surgical debridement. Int Wound J 2020; 17:1019-1027. [PMID: 32298049 DOI: 10.1111/iwj.13368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/29/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Siwei Liu
- Department of Nuclear Medicine Zhongshan Hospital, Fudan University Shanghai China
- Nuclear Medicine Institute of Fudan University Shanghai China
- Shanghai Institute of Medical Imaging Shanghai China
| | - Jie Zhang
- Department of Nuclear Medicine Zhongshan Hospital, Fudan University Shanghai China
- Nuclear Medicine Institute of Fudan University Shanghai China
- Shanghai Institute of Medical Imaging Shanghai China
| | - Hongyan Yin
- Department of Nuclear Medicine Zhongshan Hospital, Fudan University Shanghai China
- Nuclear Medicine Institute of Fudan University Shanghai China
- Shanghai Institute of Medical Imaging Shanghai China
| | - Lifang Pang
- Department of Nuclear Medicine Zhongshan Hospital, Fudan University Shanghai China
- Nuclear Medicine Institute of Fudan University Shanghai China
- Shanghai Institute of Medical Imaging Shanghai China
| | - Bing Wu
- Department of Nuclear Medicine Zhongshan Hospital, Fudan University Shanghai China
- Nuclear Medicine Institute of Fudan University Shanghai China
- Shanghai Institute of Medical Imaging Shanghai China
| | - Hongcheng Shi
- Department of Nuclear Medicine Zhongshan Hospital, Fudan University Shanghai China
- Nuclear Medicine Institute of Fudan University Shanghai China
- Shanghai Institute of Medical Imaging Shanghai China
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18
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Recommendations for Preoperative Assessment and Shared Decision-Making in Cardiac Surgery. CURRENT ANESTHESIOLOGY REPORTS 2020; 10:185-195. [PMID: 32431570 DOI: 10.1007/s40140-020-00377-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of review Recommendations about shared decision-making and guidelines on preoperative evaluation of patients undergoing non-cardiac surgery are abundant, but respective recommendations for cardiac surgery are sparse. We provide an overview of available evidence. Recent findings While there currently is no consensus statement on the preoperative anesthetic evaluation and shared decision-making for the adult patient undergoing cardiac surgery, evidence pertaining to specific organ systems is available. Summary We provide a comprehensive review of available evidence pertaining to preoperative assessment and shared decision-making for patients undergoing cardiac surgery and recommend a thorough preoperative workup in this vulnerable population.
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19
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Bhatt PJ, Ali M, Rana M, Patel G, Sullivan T, Murphy J, Pinney S, Anyanwu A, Huprikar S, Taimur S. Infections due to multidrug-resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes. Transpl Infect Dis 2019; 22:e13215. [PMID: 31765045 DOI: 10.1111/tid.13215] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/02/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infections secondary to multidrug-resistant organisms (MDRO) have emerged as a growing problem in solid organ transplantation (SOT). Most of the published data on MDRO infections in SOT pertains to abdominal organ transplantation and data specific to heart transplantation (HT) are limited. METHODS This is a retrospective review of HT recipients at our institution from 2011 to 2016; with the aim to investigate the epidemiology, microbiologic spectrum, and outcomes in patients with post-HT MDRO infections, classified as multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) using standardized definitions. RESULTS Of the 149 HT recipients, 82 episodes of bacterial infection were seen in 46 patients (31%) in the year following HT. Thirty (37%) were due to MDR pathogens and 13 (16%) were XDR. The most common gram-negative MDR pathogens were extended-spectrum beta-lactamase (ESBL) Escherichia coli and Klebsiella pneumoniae; while XDR pathogens were most commonly Pseudomonas aeruginosa followed by carbapenem-resistant Klebsiella pneumoniae. Majority of infection episodes were bloodstream (54, 66%) followed by pulmonary infection (20, 24%). Within a year after transplant, HT recipients with any bacterial infection had significantly higher mortality versus those without infection; and XDR infections were associated with a 26-fold greater hazard of death on average compared to those without infection (adjusted HR, 26.1; 95% CI, 6.4-107.0; P < .001). There were no PDR infections. CONCLUSION Bacterial infections were a significant predictor of 1-year post-HT mortality, which was highest among those with XDR infections. This study highlights the burden of MDRO infections in HT recipients and identifies an area of future research.
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Affiliation(s)
- Pinki J Bhatt
- Department of Medicine, Division of Infectious Diseases, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mohsin Ali
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Meenakshi Rana
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gopi Patel
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Timothy Sullivan
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph Murphy
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean Pinney
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery at Mount Sinai Hospital, New York, New York
| | - Shirish Huprikar
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Taimur
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
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20
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Drossos G, Ampatzidou F, Baddour A, Madesis A, Karaiskos T. The impact of deep sternal wound infections treated by negative pressure on early, 1 year and late mortality: A longitudinal case‐control study. J Card Surg 2019; 34:1550-1555. [DOI: 10.1111/jocs.14296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- George Drossos
- Cardiothoracic Surgery Department G. Papanikolaou General Hospital Thessaloniki Greece
| | - Fotini Ampatzidou
- Cardiothoracic Intensive Care Unit G. Papanikolaou General Hospital Thessaloniki Greece
| | - Antonios Baddour
- Cardiothoracic Surgery Department G. Papanikolaou General Hospital Thessaloniki Greece
| | - Athanasios Madesis
- Cardiothoracic Surgery Department G. Papanikolaou General Hospital Thessaloniki Greece
| | - Theodoros Karaiskos
- Cardiothoracic Surgery Department G. Papanikolaou General Hospital Thessaloniki Greece
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21
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Bota O, Josten C, Borger MA, Spindler N, Langer S. Standardized Musculocutaneous Flap for the Coverage of Deep Sternal Wounds After Cardiac Surgery. Ann Thorac Surg 2019; 107:802-808. [PMID: 30620706 DOI: 10.1016/j.athoracsur.2018.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/16/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deep sternal wound infection remains a serious complication after cardiac surgery, leading to increased morbidity, mortality, and cost. The goal of our study was to develop a standardized, reproducible method to safely cover deep sternal wounds and ensure improved healing rates. METHODS The study was developed as a retrospective cohort study. We included 58 patients who received standardized latissimus dorsi flap coverage of a sternum defect wound after poststernotomy mediastinitis at our institution between September 2015 and June 2017. RESULTS The average age of the cohort was 66.75 years, and 51.72% of patients were men. The mean hospital stay was 26.83 days. Eight patients (14.75%) died during the hospital stay due to sepsis or heart failure. The average flap size was 137.13 cm2. The mean operative time was 155 minutes. Seventy-four percent of patients developed a seroma at the donor site, which was treated conservatively with compression garments and taps, and 7% of patients developed a wound dehiscence of the donor site, which was treated conservatively with dressings. The mean follow-up time was 15 weeks. All 50 surviving patients showed complete wound healing on follow-up. CONCLUSIONS The latissimus dorsi pedicled flap is a safe, reproducible technique for coverage of deep sternal wounds, with few relevant perioperative complications. By setting definite parameters for the flap dissection and by ensuring a reliable blood supply, our method enables the coverage of these complex wounds by an interdisciplinary team in any cardiovascular surgical setting.
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Affiliation(s)
- Olimpiu Bota
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
| | - Christoph Josten
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Nick Spindler
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Langer
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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22
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Comparing Negative Pressure Wound Therapy with Instillation and Conventional Dressings for Sternal Wound Reconstructions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2087. [PMID: 30859044 PMCID: PMC6382248 DOI: 10.1097/gox.0000000000002087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/09/2018] [Indexed: 01/08/2023]
Abstract
Background: Muscle flap reconstruction has become a mainstay of therapy following treatment of sternal wound complications; however, success depends on removing wound exudate and infectious material from the wound before reconstruction and closure. Importantly, time to closure is a key factor affecting morbidity/mortality and cost-to-treat for this wound type. Methods: A retrospective analysis of 30 patients who were treated for sternal wound complications between June 2015 and October 2017 was performed. After surgical debridement, group 1 patients (n = 15) received negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d), instilling 1/8-strength Dakin’s solution with a 20-minute dwell time followed by 2 hours of NPWT (-125 mm Hg); group 2 patients (n = 15) were treated with wet-to-moist dressings soaked in 1/8-strength Dakin’s solution. After muscle flap reconstruction and closure with sutures, group 1 patients received closed incision negative pressure therapy, and group 2 patients received Benzoin and wound closure strips. Data collected included time to closure, therapy duration, number of debridements/dressing changes, drain duration, and complications. Results: There was a significantly shorter time to closure (P < 0.0001) for group 1 when compared with group 2. In addition, there were fewer therapy days (P = 0.0041), fewer debridements/dressing changes (P = 0.0011), and shorter drain duration (P = 0.0001) for group 1 when compared with group 2. Conclusions: We describe a novel regimen consisting of adjunctive NPWTi-d, along with debridement and systemic antibiotics, followed by closed incision negative pressure therapy after muscle flap reconstruction and closure, to help manage preexisting sternal wounds that had failed to close following a previous cardiac procedure.
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23
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Abdou E, Westercamp M, Girgis S, Sabry M, Sayyouh O, Talaat M. Sternal surgical site infection in Egypt following coronary artery bypass graft surgery: incidence and risk factors. J Hosp Infect 2018; 100:456-458. [PMID: 29981777 DOI: 10.1016/j.jhin.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- E Abdou
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt.
| | - M Westercamp
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Girgis
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Sabry
- Ain Shams University Hospitals, Cairo, Egypt
| | - O Sayyouh
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt
| | - M Talaat
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt
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Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, Dunning J, Gudbjartsson T, Linker NJ, Sandoval E, Thielmann M, Jeppsson A, Landmesser U. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg 2017; 53:5-33. [PMID: 29029110 DOI: 10.1093/ejcts/ezx314] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Tabaja H, Hajar Z, Kanj SS. A review of eleven cases of tuberculosis presenting as sternal wound abscess after open heart surgery. Infect Dis (Lond) 2017; 49:721-727. [PMID: 28687049 DOI: 10.1080/23744235.2017.1347817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Sternal wound infection with Mycobacterium tuberculosis is an uncommon yet highly challenging disease that can be quite insidious with various presentations. We hereby provide a review of 10 cases in current literature and describe an additional case which illustrates the difficulties associated with diagnosis. METHODS We used PubMed and Google search engine to search the literature for all published papers reporting on cases of sternal M. tuberculosis infections post open-heart surgeries. RESULTS A total of 11 cases were presented, including a case of our own. The majority were males and were exposed to endemic areas. The average age was 59.6 ± 15.5 years. Coronary artery bypass surgery accounted for 73% of procedures and the average time to symptoms onset was 12.2 ± 16.6 months. Diabetes was the most reported non-cardiac comorbidity. Presenting symptoms varied and only 5 patients had other organs involved. Blood tests and radiographic studies were neither sensitive nor specific. M. tuberculosis culture on debrided tissues was the most sensitive test but often forgotten initially. Diagnostic delay was seen in almost all cases, often leading to unnecessary courses of antibiotics and aggressive surgical interventions. Finally, all patients responded well to anti-tuberculosis treatment, with reported treatment duration ranging from 9 to 12 months. CONCLUSION M. tuberculosis infection of the sternum should be suspected in late-onset sternal wound infections post open-heart surgery especially when the course is chronic and indolent.
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Affiliation(s)
- Hussam Tabaja
- a Department of Internal Medicine, Division of Infectious Diseases , American University of Beirut Medical Center , Beirut , Lebanon
| | - Zeina Hajar
- a Department of Internal Medicine, Division of Infectious Diseases , American University of Beirut Medical Center , Beirut , Lebanon
| | - Souha S Kanj
- a Department of Internal Medicine, Division of Infectious Diseases , American University of Beirut Medical Center , Beirut , Lebanon
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Gjesdal K. Scandinavian Cardiovascular Journal - 50 years anniversary. SCAND CARDIOVASC J 2016; 50:251-252. [PMID: 27735190 DOI: 10.1080/14017431.2016.1249021] [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: 10/20/2022]
Affiliation(s)
- Knut Gjesdal
- a Cardiology Department , Oslo University Hospital Ullevål, Institute of Clinical Medicine, Oslo University , Oslo , Norway
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