title: Methicillin-resistant Staphylococcus aureus infection: an independent risk factor for mortality in patients with poststernotomy mediastinitis.
abstract: OBJECTIVE
  The mortality rate of patients with poststernotomy mediastinitis remains very high. The aim of this study was to identify the risk factors associated with mortality in these patients.
  
  
  METHODS
  Surveillance of sternal surgical-site infections including mediastinitis was carried out for adult patients undergoing a sternotomy between 2004 and 2012. Criteria from the US Centers for Disease Control and Prevention were used to make the diagnosis. All data on patients with a diagnosis of mediastinitis who were included in the study and on mortality risk factors were obtained from the hospital database and then analyzed using SPPS 16.0 for Windows.
  
  
  RESULTS
  Of the 19,767 patients undergoing open heart surgery, 117 (0.39%) had poststernotomy mediastinitis; 32% of these 117 died. The independent risk factors for mortality were methicillin-resistant Staphylococcus aureus (MRSA) [odds ratio (OR) 12.11 and 95% confidence interval (CI) 3.15-46.47], intensive-care unit stays >48 h after the first operation (OR 11.21 and 95% CI 3.24-38.84) and surgery that included valve replacement (OR 6.2 and 95% CI 1.44-27.13). The mortality rate decreased significantly, dropping from 38% (34/89) between 2004 and 2008 to 14% (4/28) between 2009 and 2012 (p = 0.018).
  
  
  CONCLUSIONS
  In this study, elimination of MRSA from the hospital setting decreased the rate of mortality in patients with poststernotomy mediastinitis.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Serap
authors.initials: S
authors.lastname: Simşek Yavuz
authors.forename: Ayfer
authors.initials: A
authors.lastname: Sensoy
authors.forename: Sabahat
authors.initials: S
authors.lastname: Ceken
authors.forename: Denef
authors.initials: D
authors.lastname: Deniz
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yekeler
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000401:mortality*; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality*; D056346:Sternotomy; D013530:Surgical Wound Infection / Q000382:microbiology / Q000401:mortality*; D014481:United States