Deep sternal wound infections following open heart surgery in Iceland: a population-based study.
OBJECTIVE
The aim of this nationwide case-control study was to study the epidemiology and identify risk factors of deep sternal wound infections (DSWI) in Iceland.


METHODS
Between 1997-2004, 1 650 adults underwent open cardiac surgery in Iceland. For every infected patient four control subjects were chosen (n =163), matched for time of operation. The groups were compared by multivariable logistic regression analysis.


RESULTS
Forty one patients (2.5%) developed DSWI, most often following CABG (76%). The most common pathogens were Staphylococcus aureus (39%) and coagulase-negative staphylococci (24%). All except two patients underwent debridement and rewiring of the sternum. Length of hospital stay was significantly longer in the DSWI group with a trend for increased hospital mortality and significantly greater 1-year mortality (17% vs. 5%, p =0.02). History of stroke (OR 5.12), peripheral arterial disease (OR 5), corticosteroid use (OR 4.25), smoking (OR 3.66) and re-operation for bleeding (OR 4.66) were the strongest independent predictors for DSWI.


CONCLUSIONS
Incidence of DSWI in Iceland (2.5%) is comparable to other recently published studies, with similar risk factors and significantly reduced survival at one year following the infection.
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Steinn
S
Steingrimsson
Magnus
M
Gottfredsson
Karl G
KG
Kristinsson
Tomas
T
Gudbjartsson
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016022:Case-Control Studies; D003646:Debridement; D005260:Female; D006489:Hemostatic Techniques / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications; D011159:Population Surveillance; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013249:Sternum / Q000601:surgery*; D020521:Stroke / Q000150:complications; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D013997:Time Factors
D000305:Adrenal Cortex Hormones