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Yang J, Zhang B, Qu C, Liu L, Song Y. Analysis of Risk Factors for Sternal Wound Infection After Off-Pump Coronary Artery Bypass Grafting. Infect Drug Resist 2022; 15:5249-5256. [PMID: 36097530 PMCID: PMC9464025 DOI: 10.2147/idr.s381422] [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: 07/06/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the risk factors of deep sternal wound infection (DSWI) after off-pump coronary artery bypass grafting and its prevention and treatment strategy. Methods The clinical data of 465 patients who underwent OPCABG with a median chest incision were retrospectively analyzed. The patients were divided into the observation group (with DSWI, 32 cases) and the control group (without DSWI, 433 cases) according to the occurrence of DSWI. The preoperative, intraoperative, and postoperative clinical data relevant to DSWI were collected in both groups. The univariate and multivariate logistic regression analyses were adopted to analyze the risk factors for DSWI after OPCABG and investigateand its prevention and treatment strategy. Results DSWI occurred in 32 cases with an incidence of infection of 6.89%. There were 5 cases died in the observation group (with DSWI), the overall mortality rate was 1.07% and the intra-group mortality rate was 15.6%. There were 16 cases died in the control group (without DSWI) because of low cardiac output syndrome and multiple organ failure, the overall and intra-group mortality rates were 3.44% and 3.69% respectively. By analyzing the risk factors of DSWI between the two groups, the differences in age, body mass index (BMI), history of diabetes mellitus (DM), operation time, tracheal intubation time, time of stay in thecardiac care unit, blood transfusion (blood plasma)>800mL, blood transfusion (erythrocyte suspension)>6um, secondary thoracotomy were statistically significant between the observation and control groups (P < 0.05 in all). Conclusion Obesity, history of DM, prolonged operation time and tracheal intubation time, time of stay in CCU, utilization of blood product and secondary thoracotomy were DSWI independent risk factors after OPCABG.Some preventive measure should been implemented to reduce the incidence of DSWI, such as shorter operation time and tracheal intubation time, reducing the utilization of blood product.
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Affiliation(s)
- Jian Yang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Bin Zhang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Chengliang Qu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Li Liu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
| | - Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People's Republic of China
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Yu Q, Cen C, Gao M, Yuan H, Liu J. Combination of early Interleukin-6 and -18 levels predicts postoperative nosocomial infection. Front Endocrinol (Lausanne) 2022; 13:1019667. [PMID: 36299462 PMCID: PMC9589414 DOI: 10.3389/fendo.2022.1019667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The inflammatory response plays a critical role in postoperative nosocomial infections, which are the most common postoperative complications causing adverse events and poor postoperative outcomes. This study aimed to explore the ability of early inflammation-related factor levels to predict the occurrence of nosocomial infections after abdominal surgery. METHODS The study included 146 patients with open abdominal surgery (a nosocomial infection group (NI group, n=42) and a no-nosocomial infection group (NNI group, n=104)). After 1:1 matching, the patients were divided into a matching nosocomial infection group (M-NI group, n=25) and a matching no-nosocomial infection group (M-NNI group, n=25). Serum levels of interleukin (IL)-6, IL-8, IL-10, IL-12, IL-18, macrophage migration inhibitory factor (MIF), and monocyte chemotactic protein (MCP-1) were tested at three time points (pre-operation, 0-hour post-operation (POD1) and 24-hour post-operation (POD2)). The area under the receiver operating characteristic curve (AUC-ROC) was used to test the predictive abilities. RESULTS There were significant differences in the levels of IL-6, IL-12, and IL-18 between the M-NI and M-NNI groups (p < 0.05), but not in the levels of other inflammatory factors. MIF, IL-8, and MCP-1 levels were higher in the M-NI group than in the M-NNI group at POD2 (p < 0.05). In the ROC analysis, the AUC for prediction of nosocomial infection using a combination of IL-6 and IL-18 at POD1 was 0.9616, while the AUCs for IL-6 alone and IL-12 alone were 0.8584 and 0.8256, respectively. CONCLUSIONS The combination of the levels of inflammatory factors, IL-6 and IL-18, at the 0-hour postoperative time point, significantly improved the predictive ability to the development of postoperative infection during perioperative period. Our study suggests the importance of monitoring postoperative inflammatory markers.
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Affiliation(s)
- Qingwei Yu
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chaoqun Cen
- Department of Emergency Medicine, Third Xiangya Hospital, Central South University, Changsha, China
| | - Min Gao
- Department of Intensive Medicine, Third Xiangya Hospital, Central South University, Changsha, China
| | - Hong Yuan
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Liu
- Department of Intensive Medicine, Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jingjing Liu,
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Ayed HB, Yaich S, Trigui M, Jemaa MB, Hmida MB, Karray R, Kassis M, Mejdoub Y, Feki H, Jedidi J, Damak J. Prevalence and risk factors of health care-associated infections in a limited resources country: A cross-sectional study. Am J Infect Control 2019; 47:945-950. [PMID: 30777390 DOI: 10.1016/j.ajic.2019.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this study was to determine the prevalence of health care-associated infections (HAI) in our university hospitals (UH) and to delineate the risk factors associated with HAI. METHODS We conducted a cross-sectional study in the 2 UH of Sfax, Tunisia on July 2017, including all patients hospitalized for at least 48 hours. It was a 1-day pass per department and a 1-week prevalence survey per UH. RESULTS Of 752 patients eligible for the study, the total number of HAI was 82, representing an overall prevalence of HAI of 10.9%. Respiratory tract infections were the most prevalent HAI (36.6%). In multivariate analysis, intrinsic risk factors independently associated with HAI were immune-suppression (adjusted odds ratio (AOR) = 2.8; P < .001), diabetes (AOR = 2.2; P = .008), and malnutrition (AOR = 2.2; P = .019). Extrinsic risk factors were endotracheal intubation (AOR = 17; P = .01), transfer to another department (AOR = 9; P = .019), parental feeding (AOR = 7.2; P = .014), tobacco use (AOR = 6.3; P = .004), as well as surgical wound class contaminated or dirty (AOR = 6.3; P = .002), and peripheral venous catheter (AOR = 4.7; P = .006). CONCLUSIONS Our study highlighted the magnitude of the HAI problem threatening the quality of care in Southern Tunisia. A wise identification of HAI risk factors may help health care workers to ascertain the avoidability of these infections.
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Affiliation(s)
- Houda Ben Ayed
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029.
| | - Sourour Yaich
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Maroua Trigui
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Maissa Ben Jemaa
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Mariem Ben Hmida
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Raouf Karray
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Mondher Kassis
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Yosra Mejdoub
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Habib Feki
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Jihène Jedidi
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Jamel Damak
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
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Xu X, Yang X, Li S, Luo M, Qing Y, Zhou X, Xue J, Qiu J, Li Y. Risk factors of lower respiratory tract infection in patients after tracheal intubation under general anesthesia in the Chinese health care system: A meta-analysis. Am J Infect Control 2016; 44:e215-e220. [PMID: 27614709 DOI: 10.1016/j.ajic.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) after tracheal intubation under general anesthesia poses a serious threat to worldwide health care systems, especially those in developing countries. However, a significant number of studies have found inconsistent results in their investigation of the corresponding risk factors. METHODS Relevant articles published up to September 2015 were retrieved from PubMed, Ovid, Embase, China National Knowledge Infrastructure, Chinese Biological Medical Database, China Science and Technology Journal Database, and Wanfang Data. The z test was used to determine the significance of the pooled odds ratio (OR). ORs and 95% confidence intervals were used to compare the risk factors of LRTI after intubation under general anesthesia. RESULTS Fifteen case-control studies that included 27,304 participants were identified. We identified the following variables as independent risk factors: duration of general anesthesia >3 hours (OR, 2.45), age >60 years (OR, 2.35), normal endotracheal tube (OR, 1.63), deep intubation (OR, 2.66), unpracticed intubation (OR, 2.61), postoperative extubation time >2 hours (OR, 3.76), smoking history (OR, 3.02), chronic respiratory disease history (OR, 2.30), incomplete extubation indication (OR, 3.54), thoracic or craniocerebral surgery (OR, 1.90), and emergent surgery (OR, 2.54). CONCLUSIONS Eleven risk factors, including surgery, anesthesia, and health condition, were related to LRTI after intubation under general anesthesia. Given the limitations of this study, well-designed epidemiologic studies with a large sample size should be performed in the future.
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Affiliation(s)
- Xuan Xu
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xianxian Yang
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Shangyingying Li
- Department of Anesthesiology, The Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Mei Luo
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Ying Qing
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xipeng Zhou
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jian Xue
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jingfu Qiu
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yingli Li
- Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
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