title: Surgical-site infection after cardiac surgery: incidence, microbiology, and risk factors.
abstract: OBJECTIVE
  To identify risk factors associated with surgical-site infection according to the depth of infection, the cardiac procedure, and the National Nosocomial Infections Surveillance System risk index.
  
  
  METHODS
  Prospective survey conducted during a 12-month period.
  
  
  METHODS
  A 48-bed cardiac surgical department in a teaching hospital.
  
  
  METHODS
  Patients admitted for cardiac surgery between February 2002 and January 2003.
  
  
  RESULTS
  Surgical-site infections were diagnosed in 3% of the patients (38 of 1,268). Of the 38 surgical-site infections, 20 were superficial incisional infections and 18 were mediastinitis for incidence rates of 1.6% and 1.4%, respectively. Cultures were positive in 28 cases and the most commonly isolated pathogen was Staphylococcus. A National Nosocomial Infections Surveillance System risk index score of 2 or greater was associated with a risk of surgical-site infection (relative risk, 2.4; P < .004). Heart transplantation, mechanical circulatory assistance, coronary artery bypass graft with the use of internal mammary artery, and reoperation for cardiac tamponade or pericard effusion were independent risk factors associated with surgical-site infection.
  
  
  CONCLUSIONS
  Data surveillance using incidence rates stratified by cardiac procedure and type of infection is relevant to improving infection control efforts. Risk factors in patients who developed superficial infection were different from those in patients who developed mediastinitis. Coronary artery bypass graft using internal mammary artery was associated with a high risk of surgical-site infection, and independent factors such as reoperation for cardiac tamponade or pericard effusion increased the risk of infection.
authors.affiliation: Bacteriology and Infection Control Laboratory and the Department of Cardiac Surgery, Laennec Hospital, Nantes, France. didier.lepelletier@chu-nantes.fr
authors.forename: Didier
authors.initials: D
authors.lastname: Lepelletier
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Perron
authors.forename: Philippe
authors.initials: P
authors.lastname: Bizouarn
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Caillon
authors.forename: Henri
authors.initials: H
authors.lastname: Drugeon
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Michaud
authors.forename: Daniel
authors.initials: D
authors.lastname: Duveau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D013210:Staphylococcus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*