Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting.
OBJECTIVE
Our objective was to identify risk factors for deep sternal site infection after coronary artery bypass grafting at a community hospital.


METHODS
We compared the prevalence of deep sternal site infection among patients having coronary artery bypass grafting during the study (January 1995-March 1998) and pre-study (January 1992-December 1994) periods. We compared any patient having a deep sternal site infection after coronary artery bypass graft surgery during the study period (case-patients) with randomly selected patients who had coronary artery bypass graft surgery but no deep sternal site infection during the same period (control-patients).


RESULTS
Deep sternal site infections were significantly more common during the study than during the pre-study period (30/1796 [1.7%] vs 9/1232 [0.7%]; P =.04). Among 30 case-patients, 29 (97%) returned to the operating room for sternal debridement or rewiring, and 2 (7%) died. In multivariable analyses, cefuroxime receipt 2 hours or more before incision (odds ratio = 5.0), diabetes mellitus with a preoperative blood glucose level of 200 mg/dL or more (odds ratio = 10.2), and staple use for skin closure (odds ratio = 4.0) were independent risk factors for deep sternal site infection. Staple use was a risk factor only for patients with a normal body mass index.


CONCLUSIONS
Appropriate timing of antimicrobial prophylaxis, control of preoperative blood glucose levels, and avoidance of staple use in patients with a normal body mass index should prevent deep sternal site infection after coronary artery bypass graft operations.
Trick
W E
WE
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA, USA. wbt9@cdc.gov
Scheckler
W E
WE
Tokars
J I
JI
Jones
K C
KC
Reppen
M L
ML
Smith
E M
EM
Jarvis
W R
WR
D000368:Aged; D016022:Case-Control Studies; D002444:Cefuroxime / Q000008:administration & dosage / Q000009:adverse effects; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D015995:Prevalence; D012086:Reoperation; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D013537:Sutures / Q000009:adverse effects
D002511:Cephalosporins; D002444:Cefuroxime