Harvest surgical site infection following coronary artery bypass grafting: risk factors, microbiology, and outcomes.
BACKGROUND
Our goals were to evaluate the risk factors predisposing to saphenous vein harvest surgical site infection (HSSI), the microbiology implicated, associated outcomes including 30-day mortality, and identify opportunities for prevention of infection.


METHODS
All patients undergoing coronary artery bypass grafting (CABG) procedures from January 2000 through September 2004 were included. Data were collected on preoperative, intraoperative, and postoperative factors, in addition to microbiology and outcomes.


RESULTS
Eighty-six of 3578 (2.4%) patients developed HSSI; 28 (32.6%) of them were classified as deep. The median time to detection was 17 (range, 4-51) days. An organism was identified in 64 (74.4%) cases; of them, a single pathogen was implicated in 50 (78%) cases. Staphylococcus aureus was the most frequently isolated pathogen: 19 (38% [methicillin-susceptible S aureus (MSSA) = 12, methicillin-resistant S aureus (MRSA) = 7]). Gram-negative organisms were recovered in 50% of cases, with Pseudomonas aeruginosa predominating in 11 (22%) because of a single pathogen. Multiple pathogens were identified in 14 (22%) cases. The 30-day mortality was not significantly different in patients with or without HSSI. Multivariate analysis showed age, diabetes mellitus, obesity, congestive heart failure, renal insufficiency, and duration of surgery to be associated with increased risk.


CONCLUSIONS
Diabetes mellitus, obesity, congestive heart failure, renal insufficiency, and duration of surgery were associated with increased risk for HSSI. S aureus was the most frequently isolated pathogen.
Sharma
Mamta
M
Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center, Detroit, MI, USA. mamta.sharma@stjohn.org
Fakih
Mohamad G
MG
Berriel-Cass
Dorine
D
Meisner
Susan
S
Saravolatz
Louis
L
Khatib
Riad
R
D000367:Age Factors; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D051437:Renal Insufficiency / Q000150:complications; D012307:Risk Factors; D012501:Saphenous Vein / Q000382:microbiology / Q000637:transplantation*; D018571:Sentinel Surveillance; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome