RESUMEN
OBJECTIVE: To evaluate the effect of an optimized policy for antibiotic prophylaxis on surgical site infection (SSI) rates in cardiac surgery. DESIGN: Prospective cohort study. SETTING: Tertiary medical center in Israel. METHODS: SSIs were recorded during a 10-year study period and ascertained through routine surveillance using the National Healthcare Safety Network (NHSN) methodology. Multivariable analyses were conducted to determine which significant covariates, including the administration of preoperative prophylaxis, affected these outcomes. RESULTS: A total of 2,637 of 3,170 evaluated patients were included, and the overall SSI rate was 8.4%. A greater than 50% reduction in SSI rates was observed in the last 4 years of the study. Overall and site-specific infection rates were similar for patients receiving cefazolin or vancomycin. SSIs developed in 206 (8.1%) of the 2,536 patients who received preoperative prophylaxis (within 2 hours of the first incision) compared with 14 (13.9%) of 101 patients who received antibiotic prophylaxis at a different time (P = .04; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.3). After accounting for covariates, preoperative hospital stay (5 days or more), an NHSN risk category (2 or 3), age (60 years or more), surgeon's role, and the period of measurement were significantly associated with SSIs. Emergency surgery, age, surgeon's role, and nonpreoperative prophylaxis were found to be independent predictors of superficial SSI. CONCLUSIONS: We observed a progressive and significant decrease in SSI rates after the implementation of an infection control program that included an optimized policy of preoperative prophylaxis in cardiac surgery.
Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Cefazolina/uso terapéutico , Infección de la Herida Quirúrgica/prevención & control , Vancomicina/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica/métodos , Cefazolina/administración & dosificación , Urgencias Médicas , Femenino , Humanos , Control de Infecciones , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/microbiología , Cirugía Torácica , Factores de Tiempo , Vancomicina/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: To evaluate the impact of an infection control program on surgical site infections (SSIs) complicating cardiac operations. METHODS: Prospective cohort study of patients undergoing cardiac operations. Interventions included prospective surveillance, povidone-iodine scrub showers, depilation before surgery, administration of preoperative antibiotic prophylaxis in the operating room, and postdischarge follow-up. Logistic regression models were fitted to assess infection rates over time, adjusting for factors known to affect SSI rates. RESULTS: The overall SSI rate for 2051 procedures was 10.4%. Rates of superficial and deep incisional SSIs remained unchanged over the study period. The rates of all organ/space infections, mediastinitis, and SSIs because of methicillin-resistant Staphylococcus aureus during the first 2 years were 3.25%, 2.22%, and 1.48%, respectively, and they decreased to 1.17%, 0.73%, and 0.73%, respectively, by the end of 2002 (P = .01, P = .01, and P = .09, respectively). The adjusted odds ratios for these 3 types of infection at the end of 2002 compared with December 31, 1998, were 0.19 (95% confidence interval [95% CI]: 0.07-0.48), 0.20 (95% CI: 0.06-0.66), and 0.28 (95% CI: 0.08-0.97), respectively. CONCLUSION: We observed significant reductions in organ/space infection rates, particularly mediastinitis. These differences remained significant when adjusted for potential confounding variables.
Asunto(s)
Infección Hospitalaria/epidemiología , Control de Infecciones/métodos , Infección de la Herida Quirúrgica/epidemiología , Cirugía Torácica , Infección Hospitalaria/microbiología , Hospitales , Humanos , Pacientes Internos , Mediastinitis/epidemiología , Mediastinitis/microbiología , Resistencia a la Meticilina , Infecciones Estafilocócicas/epidemiología , Infección de la Herida Quirúrgica/microbiologíaRESUMEN
BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement (AVR) in patients with previous coronary artery bypass grafting (CABG) and a patent pedicled internal mammary artery (IMA) is often complicated by a need to dissect and clamp the IMA to achieve optimal myocardial protection. Eliminating this need may simplify and facilitate surgery; hence, a new surgical technique for use in these patients is described. METHODS: Five patients with previous CABG and functioning IMA who required AVR between January 1998 and October 2002 were studied. In all patients, the IMA was neither dissected nor clamped. Myocardial protection comprised an initial bolus of antegrade cardioplegia, followed by continuous retrograde infusion of tepid non-diluted oxygenated blood, supplemented with cardioplegic drugs to maintain cardiac arrest. The systemic and myocardial temperature was 30-32 degrees C. RESULTS: All patients underwent surgery as planned, and there was no operative mortality or myocardial infarction. One patient sustained a minor stroke. None of the IMA was injured. CONCLUSION: In patients requiring AVR, it is both possible and reasonable to leave the IMA undissected and unclamped. Limited experience suggests that this new technique provides adequate myocardial protection, while keeping surgery both simple and safe.