title: Impact of an Institutional Antimicrobial Stewardship Program on Bacteriology of Surgical Site Infections in Cardiac Surgery.
abstract: BACKGROUND
  Surgical site infections (SSIs) occur in 1% to 4% of cardiac surgery patients and are associated with significantly reduced survival. The present study evaluated trends in the incidence and bacteriology of SSIs before and after the implementation of an antimicrobial stewardship program.
  
  
  METHODS
  Starting in 2010, our institution utilized a protocol that included daily chlorhexidine baths, and strict cessation of prophylactic antibiotics after 48 hours. We used our institutional Society of Thoracic Surgery Database to identify all adult patients who underwent cardiac operations. Data from the microbiology laboratory were used to identify SSIs. Patients undergoing cardiac surgery between January 2008 and December 2010 (pre-stewardship group: PRE) and January 2011 and December 2012 (post-stewardship group: POST) were compared.
  
  
  RESULTS
  Of the 3233 patients who underwent cardiac surgery during the study period, 23 (0.71%) developed SSIs (PRE: 0.69%, POST: 0.75%, p = 0.843). The proportion of gram positive, gram negative, fungal, and anaerobic organisms was not significantly different between time periods. The most commonly identified organisms were Staphylococcus aureus, Enterococcus spp., and Pseudomonas aeruginosa.
  
  
  CONCLUSIONS
  Despite changes in antibiotic prophylaxis duration and postoperative skin treatment, our data demonstrate a stable incidence and composition of surgical wound infections during the study period. doi: 10.1111/jocs.12756 (J Card Surg 2016;31:367-372).
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Adeel
authors.initials: A
authors.lastname: Ashfaq
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Allen
authors.initials: A
authors.lastname: Zhu
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Amit
authors.initials: A
authors.lastname: Iyengar
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Hoover
authors.initials: H
authors.lastname: Wu
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Romney
authors.initials: R
authors.lastname: Humphries
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: James A
authors.initials: JA
authors.lastname: McKinnell
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Richard
authors.initials: R
authors.lastname: Shemin
authors.affiliation: Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Peyman
authors.initials: P
authors.lastname: Benharash
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001494:Baths; D006348:Cardiac Surgical Procedures; D002710:Chlorhexidine / Q000627:therapeutic use; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control
chemical_list: D000890:Anti-Infective Agents; D002710:Chlorhexidine