Study of Type and Antimicrobial Resistance in Sternal Wound Infection Following Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Nosocomial Infection Research Center AND Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran

4 Lecturer, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 MSc Student, Department of Microbiology, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Sternal ulcer infections have a great importance and complexity following coronary artery bypass graft (CABG) surgery. Although this kind of infection has a low prevalence but the complications are severe. The purpose of this study was to determine the type of microorganism and antibacterial resistance in sternal wound infections following CABG surgery in Shahid Chamran hospital in Isfahan, Iran, from 2009 to 2012.Methods: In this descriptive and analytical study, 275 cases of CABG operation were entered. Sternal wound secretion samples of suspected patients were cultured and the type of the causative bacteria were determined. Also, antibiogram test was done on the grown strains and antibacterial resistance patterns were determined.Findings: Of 275 CABG surgeries, 13 cultured sternal wound samples showed positive bacterial colonization. The types of bacterial samples were Staphylococcus epidermidis, Klebsiella, Escherichia coli and Pseudomonas in four, four, three and two cases, respectively. The mean age of patients with and without sternal ulcer infection had no specific differences (P = 0.43). The differences of sex distribution between the case and control group was not statistically significant (P = 0.31), but having diabetes was significantly different between the groups (P < 0.01). Aortic clamping time and body mass index (BMI) showed no significant differences between the groups (P > 0.05).Conclusion: The incidence of sternal infection in patients undergone CABG surgery in this study was moderate compared to other studies; this is influenced by several factors including host, staff relating, environmental and medical equipments factors. Therefore, it is necessary to implement preventive measures at the time of hospitalization and provide appropriate educational programs and preventive methods for staff, patients and their families.

Keywords

References

  1. Banbury MK. Experience in prevention of sternal wound infections in nasal carriers of Staphylococcus aureus. Surgery 2003; 134(5 Suppl): S18-S22.
  2. Jablanov J, Albreht M, Todoric M, Aleksandrov R, Ilic R, Mandaric V. Infections of the sternum after cardiac surgery. Vojnosanit Pregl 1993; 50(2): 134-40. [In Serbian].
  3. Omura K, Misaki T, Takahashi H, Kobayashi K, Watanabe Y. Omental transfer for the treatment of sternal infection after cardiac surgery: report of three cases. Surg Today 1994; 24(1): 67-71.
  4. Shimasaki T, Masaoka T, Hirooka S, Abe H, Watanabe T, Washio M. Hygienic handling in cardiac surgery. Kyobu Geka 1993; 46(4): 319-20. [In Japanese].
  5. Kirklin JW, Barratt-Boyes BG. Cardiac surgery. 2nd ed. New York, NY: Churchill Livingstone; 1993. p. 224-5.
  6. Stahle E, Tammelin A, Bergstrom R, Hambreus A, Nystrom SO, Hansson HE. Sternal wound complications--incidence, microbiology and risk factors. Eur J Cardiothorac Surg 1997; 11(6): 1146-53.
  7. Mossad SB, Serkey JM, Longworth DL, Cosgrove DM, III, Gordon SM. Coagulase-negative staphylococcal sternal wound infections after open heart operations. Ann Thorac Surg 1997; 63(2): 395-401.
  8. Eklund AM. Prevention of sternal wound infections with locally administered gentamicin. APMIS 2007; 115(9): 1022-4.
  9. Tegnell A, Aren C, Ohman L. Coagulase-negative staphylococci and sternal infections after cardiac operation. Ann Thorac Surg 2000; 69(4): 1104-9.
  10. Eklund AM, Lyytikainen O, Klemets P, Huotari K, Anttila VJ, Werkkala KA, et al. Mediastinitis after more than 10,000 cardiac surgical procedures. Ann Thorac Surg 2006; 82(5): 1784-9.
  11. Woodward CS, Son M, Taylor R, Husain SA. Prevention of sternal wound infection in pediatric cardiac surgery: a protocolized approach. World J Pediatr Congenit Heart Surg 2012; 3(4): 463-9.
  12. Berman M, Stamler A, Sahar G, Georghiou GP, Sharoni E, Brauner R, et al. Validation of the 2000 Bernstein-Parsonnet score versus the EuroSCORE as a prognostic tool in cardiac surgery. Ann Thorac Surg 2006; 81(2): 537-40.
  13. Souza Neto EP, Celard M, Durand PG, Ninet J, Lehot JJ. Fulminant mediastinitis from Streptococcus pneumoniae following cardiac surgery. Ann Fr Anesth Reanim 2002; 21(7): 603-5. [In French].
  14. Copeland M, Senkowski C, Ulcickas M, Mendelson M, Griepp RB. Breast size as a risk factor for sternal wound complications following cardiac surgery. Arch Surg 1994; 129(7): 757-9.
  15. Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Obesity is not a risk factor for significant adverse outcomes after cardiac surgery. Circulation 1996; 94(9 Suppl): II87-II92.
  16. Pertowski CA, Baron RC, Lasker BA, Werner SB, Jarvis WR. Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse. J Infect Dis 1995; 172(3): 817-22.
  17. Mousavi SA, Miri M, Akhoondzadeh R, Mousavi F. Management in hospital sterilization centers. Tehran, Iran: Khosravi Publications; 2005. [In Persian].
  18. Gardlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery - microbiology and pathogenesis. Eur J Cardiothorac Surg 2002; 21(5): 825-30.
  19. Wilson AP, Gruneberg RN, Treasure T, Sturridge MF. Staphylococcus epidermidis as a cause of postoperative wound infection after cardiac surgery: assessment of pathogenicity by a wound-scoring method. Br J Surg 1988; 75(2): 168-70.
  20. Antoniali F, da Costa CE, Tarelho LDS; Lopes MM, de Albuquerque PN; Reinert GAA, et al. The impact of new preventive measures and treatment of surgical site infections after coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc 2005; 20(4): 382-91.
  21. Sharma M, Berriel-Cass D, Baran J, Jr. Sternal surgical-site infection following coronary artery bypass graft: prevalence, microbiology, and complications during a 42-month period. Infect Control Hosp Epidemiol 2004; 25(6): 468-71.
  22. Hall RE, Ash AS, Ghali WA, Moskowitz MA. Hospital cost of complications associated with coronary artery bypass graft surgery. Am J Cardiol 1997; 79(12): 1680-2.
  23. Taylor GJ, Mikell FL, Moses HW, Dove JT, Katholi RE, Malik SA, et al. Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications. Am J Cardiol 1990; 65(5): 309-13.
  24. Karabay O, Fermanci E, Silistreli E, Aykut K, Yurekli I, Catalyurek H, et al. Intracutaneous versus transcutaneous suture techniques: comparison of sternal wound infection rates in open-heart surgery patients. Tex Heart Inst J 2005; 32(3): 277-82.
Journal of Isfahan Medical School
Volume 31, Issue 241 - Serial Number 241
May and June 2013
Pages 885-893

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History

  • Receive Date: 23 June 2013
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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