title: Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting.
abstract: 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.
authors.affiliation: Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA, USA. wbt9@cdc.gov
authors.forename: W E
authors.initials: WE
authors.lastname: Trick
authors.forename: W E
authors.initials: WE
authors.lastname: Scheckler
authors.forename: J I
authors.initials: JI
authors.lastname: Tokars
authors.forename: K C
authors.initials: KC
authors.lastname: Jones
authors.forename: M L
authors.initials: ML
authors.lastname: Reppen
authors.forename: E M
authors.initials: EM
authors.lastname: Smith
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: 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
chemical_list: D002511:Cephalosporins; D002444:Cefuroxime