title: Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation.
abstract: The incidence of surgical site infection (SSI) after cardiac surgery depends on the definition used. A distinction is generally made between mediastinitis, as defined by the US Centers for Disease Control and Prevention (CDC), and superficial SSI. Our objective was to decipher these entities in terms of presentation and risk factors. We performed a 7-year single centre analysis of prospective surveillance of patients with cardiac surgery via median sternotomy. SSI was defined as the need for reoperation due to infection. Among 7170 patients, 292 (4.1%) developed SSI, including 145 CDC-defined mediastinitis (CDC-positive SSI, 2.0%) and 147 superficial SSI without associated bloodstream infection (CDC-negative SSI, 2.1%). Median time to reoperation for CDC-negative SSI was 18 days (interquartile range, 14-26) and 16 (interquartile range, 11-24) for CDC-positive SSI (p 0.02). Microorganisms associated with CDC-negative SSI were mainly skin commensals (62/147, 41%) or originated in the digestive tract (62/147, 42%); only six were due to Staphylococcus aureus (4%), while CDC-positive SSI were mostly due to S. aureus (52/145, 36%) and germs from the digestive tract (52/145, 36%). Risk factors for SSI were older age, obesity, chronic obstructive bronchopneumonia, diabetes mellitus, critical preoperative state, postoperative vasopressive support, transfusion or prolonged ventilation and coronary artery bypass grafting, especially if using both internal thoracic arteries in female patients. The number of internal thoracic arteries used and factors affecting wound healing were primarily associated with CDC-negative SSI, whereas comorbidities and perioperative complications were mainly associated with CDC-positive SSI. These 2 entities differed in time to revision surgery, bacteriology and risk factors, suggesting a differing pathophysiology.
authors.affiliation: Infection Control Unit, France; IAME, UMR 1137, INSERM, F-75018 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Lemaignen
authors.affiliation: Infection Control Unit, France; IAME, UMR 1137, INSERM, F-75018 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Birgand
authors.affiliation: Cardiac Surgery Department, France.
authors.forename: W
authors.initials: W
authors.lastname: Ghodhbane
authors.affiliation: Cardiac Surgery Department, France.
authors.forename: S
authors.initials: S
authors.lastname: Alkhoder
authors.affiliation: Infection Control Unit, France.
authors.forename: I
authors.initials: I
authors.lastname: Lolom
authors.affiliation: Infection Control Unit, France.
authors.forename: S
authors.initials: S
authors.lastname: Belorgey
authors.affiliation: Infectious Diseases Department, France; IAME, UMR 1137, INSERM, F-75018 Paris, France.
authors.forename: F-X
authors.initials: FX
authors.lastname: Lescure
authors.affiliation: Bacteriology Laboratory, France; IAME, UMR 1137, INSERM, F-75018 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Armand-Lefevre
authors.affiliation: Cardiac Surgery Department, France.
authors.forename: R
authors.initials: R
authors.lastname: Raffoul
authors.affiliation: Department of Anesthesiology, Bichat-Claude Bernard Hospital, Assistance Publique, Hôpitaux de Paris, France.
authors.forename: M-P
authors.initials: MP
authors.lastname: Dilly
authors.affiliation: Cardiac Surgery Department, France.
authors.forename: P
authors.initials: P
authors.lastname: Nataf
authors.affiliation: Infection Control Unit, France; IAME, UMR 1137, INSERM, F-75018 Paris, France. Electronic address: jean-christophe.lucet@bch.aphp.fr.
authors.forename: J C
authors.initials: JC
authors.lastname: Lucet
mesh_terms: D000368:Aged; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*
keywords: Adult; France; cardiac surgical procedures; cross infection; epidemiology; mediastinitis; microbiology; pathophysiology; risk factors; surgical wound infection