title: Sternal surgical-site infection following coronary artery bypass graft: prevalence, microbiology, and complications during a 42-month period.
abstract: OBJECTIVE
  Surgical-site infection (SSI) is a serious and costly complication following coronary artery bypass graft (CABG). We analyzed surgical factors, microbiology, and complications at a 608-bed community teaching hospital to identify opportunities for prevention.
  
  
  METHODS
  All patients undergoing CABG procedures from June 1997 through December 2000 were analyzed. Hospital records and postdischarge surveillance data were reviewed for demographics, surgical information, timing and classification of infection, microbiology, and bacteremic events.
  
  
  RESULTS
  Of 3,443 patients undergoing CABG, sternal SSI developed in 122 (3.5%); 71 (58.2%) were classified as superficial SSI and 51 (41.8%) as deep SSI. Surgical antimicrobial prophylaxis was employed in all cases. On average, infection occurred 21.5 days (range, 4 to 315) after CABG. Most cases were diagnosed on readmission (59%); 20 cases (16%) were identified by postdischarge surveillance. Microbiological data were positive in 109 (89.3%), with a single pathogen implicated in most (86.2%). Gram-positive cocci were most frequently recovered (81%); gram-negative bacilli (17%), gram-positive bacilli (1%), and yeast (1%) were less common. Staphylococcus aureus was the most frequently isolated pathogen (49%). Bacteremia was noted in 22 instances (18%). It was significantly associated with deep SSI (P =. 002) and identified only in S. aureus cases.
  
  
  CONCLUSIONS
  SSI complicated 3.5% of the procedures. S. aureus was implicated in most of the cases and was significantly associated with deep SSI. It was the only pathogen associated with secondary bacteremia. In addition to standard guidelines, targeted methods against S. aureus should help reduce the overall rate of SSI.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, St. John Hospital and Medical Center, 22101 Moross Road, Detroit, MI 48236, USA.
authors.forename: Mamta
authors.initials: M
authors.lastname: Sharma
authors.forename: Dorine
authors.initials: D
authors.lastname: Berriel-Cass
authors.forename: Joseph
authors.initials: J
authors.lastname: Baran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D018571:Sentinel Surveillance; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013249:Sternum; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D013997:Time Factors