Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery.
BACKGROUND
The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery.


OBJECTIVE
To determine the aggregate and comparative interhospital surgical-site infection (SSI) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group.


METHODS
Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected.


RESULTS
For 4,474 patients undergoing CABG surgery, the aggregate SSI rate was 7.8 infections per 100 procedures (95% confidence interval [CI95], 7.0-8.5), with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures. Multivariate risk factor analysis demonstrated age (odds ratio [OR], 1.02; CI95, 1.01-1.04; P < .001), obesity (OR, 1.8; CI95, 1.4-2.3; P < .001), and diabetes mellitus (OR, 1.6; CI95, 1.2-2.1; P < .001) as independent predictors of SSI. Three hundred thirty-four organisms were isolated from 296 SSIs. Of the total SSIs, methicillin-resistant Staphylococcus aureus was isolated from 32%, methicillin-sensitive S. aureus from 24%, gram-negative bacilli (eg, Enterobacter and Escherichia coli) from 18%, and miscellaneous organisms from the remainder.


CONCLUSIONS
We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery.
Harrington
Glenys
G
Victorian Infection Control Surveillance Project (VICSP), P.O. Box 5202, Middle Park, Victoria 3206, Australia.
Russo
Philip
P
Spelman
Denis
D
Borrell
Sue
S
Watson
Kerrie
K
Barr
Wendy
W
Martin
Rhea
R
Edmonds
Diedre
D
Cocks
Joanne
J
Greenbough
John
J
Lowe
Jill
J
Randle
Leesa
L
Castell
Jan
J
Browne
Elizabeth
E
Bellis
Kaye
K
Aberline
Melissa
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000145:classification / Q000453:epidemiology; D019985:Benchmarking; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D048909:Diabetes Complications; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D013211:Staphylococcus aureus / Q000472:pathogenicity; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D014739:Victoria / Q000453:epidemiology