title: Preoperative carriage and postoperative same-species sternal wound infection after cardiac surgery.
abstract: Sternal wound infection (SWI) after cardiac surgery remains an important problem. Prediction of pathogens involved in such infection could guide antibiotics. From April 1, 2006 to December 31, 2008, retrospectively, we evaluated the diagnostic value of preoperative methicillin-sensible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or multi-drug resistant Gram-negative bacillus (MDRGNB) carriage to predict same-pathogens involved in postoperative SWI. All patients referred for elective cardiac surgery were screened using multisite (nares, axillae, rectal) sampling at admission to detect MSSA, MRSA, and MDRGNB. Of the 1895 patients addressed, 425 patients (22.4%) were colonized at admission. Preoperative carriers more frequently developed SWI than non-carriers, respectively, 11% vs. 5.5% (P<0.05). Because of the small sample, MDRGNB carriers could not be analyzed. For prediction of MSSA SWI with preoperative MSSA carriage, the area under the receiver operating characteristic (ROC) curve was 0.720 (95% confidence interval (CI), 0.364-0.796) and 0.710 (95% CI, 0.623-0.787) for prediction of MRSA SWI with preoperative MRSA carriage. Preoperative MSSA carriage is frequent but preoperative MRSA or MDRGNB carriage remains infrequent. The ability of preoperative carriage to predict a same-pathogen-postoperative SWI was low and should not be used to guide empirical antibiotherapy.
authors.affiliation: Department of Cardio Vascular and Thoracic Intensive Care, Centre Cardiologique du Nord, Saint-Denis, France. jm.maillet@ccncardio.com
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Maillet
authors.forename: Gregoire
authors.initials: G
authors.lastname: Oghina
authors.forename: Paul
authors.initials: P
authors.lastname: Le Besnerais
authors.forename: Stéphane
authors.initials: S
authors.lastname: Thierry
authors.forename: Genevieve
authors.initials: G
authors.lastname: Bouquet
authors.forename: Patrick
authors.initials: P
authors.lastname: Mesnildrey
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonnet
authors.forename: Denis
authors.initials: D
authors.lastname: Brodaty
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology* / Q000635:transmission; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D024901:Drug Resistance, Multiple, Bacterial; D017558:Elective Surgical Procedures; D005260:Female; D005602:France; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D016017:Odds Ratio; D010502:Perineum / Q000382:microbiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012867:Skin / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology* / Q000635:transmission
chemical_list: D000900:Anti-Bacterial Agents