title: The endogenous pathway is a major route for deep sternal wound infection.
abstract: OBJECTIVE
  Deep wound infections pose an increasing problem in cardiac surgery patients. Prospective infection monitoring is thus a means of identifying possible risk factors.
  
  
  METHODS
  Within a period of 5 months, a total of 376 adult patients, 260 men and 116 women, with a mean age of 62.6 years (range 18-88), underwent coronary bypass grafting (n=281) or other cardiac surgery procedures (n=95). Nasal cultures were taken preoperatively from every patient, as well as cultures of the wound during surgery and when dressings were changed thereafter. In addition, nasal cultures were taken from all the medical and nursing staff. To differentiate endogenous and exogenous infection pathways, DNA fingerprint analysis was performed.
  
  
  RESULTS
  A total of 38 patients (10.1%) developed a wound infection, in 14 patients this happened to be a deep wound infection, in 24 patients a superficial one. Five sternal wound infections were associated with mediastinitis (1.3%). The occurrence of a wound infection overall resulted in prolonged hospitalization (29.4+/-24 vs. 11.9+/-6.9 days, P=0.001), but not in increased hospital mortality (4.4% vs. 3.9%). Obesity, diabetes mellitus and nasal carriage of Staphylococcus aureus proved to be independent risk factors with an odds ratio of 2.07, 2.26 and 2.28, respectively. In all but one of the sternal colonizations with S. aureus, DNA fingerprint analysis demonstrated an identical pattern of S. aureus from the patient's nose and sternum, indicating an endogenous infection pathway.
  
  
  CONCLUSIONS
  The determination of the endogenous pathway for severe wound infection makes prevention possible by means of preoperative local S. aureus eradication.
authors.affiliation: Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. heinz.jakob@uni-essen.de
authors.forename: H G
authors.initials: HG
authors.lastname: Jakob
authors.forename: M
authors.initials: M
authors.lastname: Borneff-Lipp
authors.forename: A
authors.initials: A
authors.lastname: Bach
authors.forename: S
authors.initials: S
authors.lastname: von Pückler
authors.forename: J
authors.initials: J
authors.lastname: Windeler
authors.forename: H
authors.initials: H
authors.lastname: Sonntag
authors.forename: S
authors.initials: S
authors.lastname: Hagl
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D009765:Obesity / Q000453:epidemiology; D012307:Risk Factors; D012867:Skin / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013249:Sternum / Q000382:microbiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology