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Erdem H, Ankarali H, Al-Tawfiq JA, Angamuthu K, Piljic D, Umihanic A, Dayyab F, Karamanlioğlu D, Pekok AU, Cagla-Sonmezer M, El-Kholy A, Gad MA, Velicki L, Akyildiz O, Altindis M, Başkol-Elik D, Erturk-Sengel B, Kara İ, Kahraman U, Özdemir M, Caskurlu H, Cag Y, Al-Khalifa A, Hakamifard A, Batinjan MKG, Tahir M, Tukenmez-Tigen E, Zajkowska J, ElKholy J, Gašparović H, Filiz M, Gul O, Tehrani HA, Doyuk-Kartal E, Aybar-Bilir Y, Kahraman H, Mikulić H, Dayan S, Cascio A, Yurdakul ES, Colkesen F, Karahangil K, Espinosa A, Rahimi BA, Vangel Z, Fasciana T, Giammanco A. Mortality Associated with Surgical Site Infections Following Cardiac Surgery: Insights from the International ID-IRI Study. IJID REGIONS 2025; 14:100566. [PMID: 39931188 PMCID: PMC11808521 DOI: 10.1016/j.ijregi.2025.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 01/02/2025] [Accepted: 01/03/2025] [Indexed: 02/13/2025]
Abstract
Objectives Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management.
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Affiliation(s)
- Hakan Erdem
- Turkish Health Sciences University, Gülhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
- Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, USA
| | - Kumar Angamuthu
- Department of Infectious Diseases, Almana General Hospitals, Dammam, Saudi Arabia
| | - Dragan Piljic
- University Clinical Center Tuzla, Department of Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina
| | - Ajdin Umihanic
- University Clinical Center Tuzla, Department of Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina
| | - Farouq Dayyab
- Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | - Dilek Karamanlioğlu
- Etlik City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Abdullah Umut Pekok
- Department of Infectious Diseases, VM Medical Park, Pendik Hospital, Istanbul, Türkiye
| | - Meliha Cagla-Sonmezer
- Hacettepe University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Amani El-Kholy
- Cairo University, Faculty of Medicine, Clinical and Chemical Pathology Department, Cairo, Egypt
| | - Maha Ali Gad
- Cairo University, Faculty of Medicine, Clinical and Chemical Pathology Department, Cairo, Egypt
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia and Institute of Cardiovascular Disease Vojvodina, Sremska Kamenica, Serbia
| | - Ozay Akyildiz
- Acibadem Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Türkiye
| | - Mustafa Altindis
- Sakarya University, Faculty of Medicine, Department of Microbiology, Sakarya, Türkiye
| | - Dilşah Başkol-Elik
- Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Türkiye
| | - Buket Erturk-Sengel
- Marmara University Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - İbrahim Kara
- Sakarya University, Faculty of Medicine, Department of Cardiovascular Surgery, Sakarya, Türkiye
| | - Umit Kahraman
- Ege University, Faculty of Medicine, Department of Cardiovascular Surgery, Izmir, Türkiye
| | - Mehmet Özdemir
- Necmettin Erbakan University, Faculty of Medicine, Department of Microbiology, Konya, Türkiye
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
| | - Abdulwahab Al-Khalifa
- University Clinical Center Tuzla, Department of Cardiovascular Surgery, Tuzla, Bosnia and Herzegovina
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marina Kljaković-Gašpić Batinjan
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia and Institute of Cardiovascular Disease Vojvodina, Sremska Kamenica, Serbia
| | - Muhammad Tahir
- Department of Medicine, Federal General Hospital, Islamabad, Pakistan
| | - Elif Tukenmez-Tigen
- Marmara University Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - Joanna Zajkowska
- Medical University in Bialystok, Department of Infectious Diseases and Neuroinfections, Bialystok, Poland
| | - Jehan ElKholy
- Cairo University Hospital, Department of Anesthesia, Pain Management, Cairo, Egypt
| | - Hrvoje Gašparović
- University Hospital Centre Zagreb, University of Zagreb, Department of Cardiac Surgery, Zagreb, Croatia
| | - Mine Filiz
- Turkish Health Sciences University, Gülhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Ozlem Gul
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - Hamed Azhdari Tehrani
- Shahid Beheshti University of Medical Sciences, Department of Hematology and Medical Oncology, Tehran, Iran
| | - Elif Doyuk-Kartal
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Türkiye
| | - Yesim Aybar-Bilir
- Etlik City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Türkiye
| | - Hasip Kahraman
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Türkiye
| | - Hrvoje Mikulić
- SKB Mostar, Department of Cardiac Surgery, Mostar, Bosnia and Herzegovina
| | - Saim Dayan
- Dicle University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Diyarbakir, Türkiye
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Eray Serdar Yurdakul
- Turkish Health Sciences University, Gulhane School of Medicine, Department of Medical History and Ethics, Ankara, Türkiye
| | - Fatma Colkesen
- Turkish Health Sciences University, Konya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology Konya, Türkiye
| | - Kadriye Karahangil
- Istanbul Medipol University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Türkiye
| | - Angel Espinosa
- Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | - Bilal Ahmad Rahimi
- Kandahar University Faculty of Medicine, Department of Pediatrics, Kandahar, Afghanistan
| | - Zdraveski Vangel
- PHI UC State Cardiac Surgery, Department of Cardiac Surgery, Skopje, North Macedonia
| | - Teresa Fasciana
- Department of Health Promotion, Maternal Childhood, Internal Medicine of Excellence G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Anna Giammanco
- Department of Health Promotion, Maternal Childhood, Internal Medicine of Excellence G. D'Alessandro, University of Palermo, Palermo, Italy
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Chen D, Zhang J, Wang Y, Jiang W, Xu Y, Xiong C, Feng Z, Han Y, Chen Y. Risk factors for sternal wound infection after open-heart operations: A systematic review and meta-analysis. Int Wound J 2024; 21:e14457. [PMID: 37909266 PMCID: PMC10898401 DOI: 10.1111/iwj.14457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
We aimed to quantitatively and systematically elucidate the rationality of the examined variables as independent risk factors for sternal wound infection. We searched databases to screen studies, ascertained the variables to be analysed, extracted the data and applied meta-analysis to each qualified variable. Odds ratios and mean differences were considered to be the effect sizes for binary and continuous variables, respectively. A random-effects model was used for these procedures. The source of heterogeneity was evaluated using a meta-regression. Publication bias was tested by funnel plot and Egger's test, the significant results of which were then calculated using trim and fill analysis. We used a sensitivity analysis and bubble chart to describe their robustness. After screening all variables in the eligible literature, we excluded 55 because only one or no research found them significant after multivariate analysis, leaving 33 variables for synthesis. Two binary variables (age over 65 years, NYHA class >2) and a continuous variable (preoperative stay) were not significant after the meta-analysis. The most robust independent risk factors in our study were diabetes mellitus, obesity, use of bilateral internal thoracic arteries, chronic obstructive pulmonary disease, prolonged surgery time, prolonged ventilation and critical preoperative state, followed by congestive heart failure, atrial fibrillation, renal insufficiency, stroke, peripheral vascular disease and use of an intra-aortic balloon pump. Relatively low-risk factors were emergent/urgent surgery, smoking, myocardial infarction, combined surgery and coronary artery bypass grafting. Sternal wound infection after open-heart surgery is a multifactorial disease. The detected risk factors significantly affected the wound healing process, but some were different in strength. Anything that affects wound healing and antibacterial ability, such as lack of oxygen, local haemodynamic disorders, malnutrition condition and compromised immune system will increase the risk, and this reminds us of comprehensive treatment during the perioperative period.
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Affiliation(s)
- Dongsheng Chen
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Jianghe Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Yuting Wang
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Weiqian Jiang
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Yujian Xu
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Chenlu Xiong
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Zekun Feng
- Department of Cardiovascular SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Yan Han
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Youbai Chen
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
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Pereira AG, Lopes JM, Pereira LCS, Bragato AGDC, de Araújo SA, Figueiredo VN, Haas VJ, Raponi MBG. Factors associated with surgical site infection in myocardial revascularization: a retrospective longitudinal study. Rev Bras Enferm 2023; 76Suppl 4:e20230108. [PMID: 38088713 PMCID: PMC10704655 DOI: 10.1590/0034-7167-2023-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES to analyze the influence of sociodemographic and clinical variables, as well as the surgical checklist adherence score, on the occurrence of surgical site infection among patients undergoing myocardial revascularization. METHODS an observational, longitudinal, retrospective study was conducted at a university hospital, involving 266 medical records of patients who underwent myocardial revascularization surgery. Instruments containing sociodemographic, clinical, and infection-related variables were used, along with the Perioperative Surgical Safety Checklist. Descriptive, bivariate, and logistic regression analyses were employed. RESULTS surgical site infection occurred in 89 (33.5%) patients. There was a statistically significant association between body temperature outside the range of 36 degrees Celsius to 36.5 degrees Celsius (p=0.01), the presence of invasive devices (p=0.05), surgical procedures with the anticipation of critical events (p<0.001), and the occurrence of infection. CONCLUSIONS body temperature, the presence of invasive devices, and surgical procedures with the anticipation of critical events were significant factors contributing to an increased risk of infection.
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Mufti HN, Jarad M, Haider MM, Azzhary L, Namnqani S, Husain I, Albugami S, Elamin W. Impact of Pre-operative Hemoglobin A1C Level and Microbiological Pattern on Surgical Site Infection After Cardiac Surgery. Cureus 2020; 12:e11851. [PMID: 33282606 PMCID: PMC7714741 DOI: 10.7759/cureus.11851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 01/19/2023] Open
Abstract
Background Surgical site infection (SSI) after cardiac surgery is a major concern. A limited number of studies have addressed the relationship of preoperative glycemic control on the risk of developing SSI after cardiac surgery. We aim to determine the incidence, microbiological pattern, and impact of preoperative hemoglobin A1C (Hgb A1C) on the development of SSI after cardiac surgery. Methods This is a single-center retrospective chart review that was performed on adult patients undergoing cardiac surgery from January 2017 to December 2018. Results Two hundred and twenty-nine patients underwent 233 procedures. The median age was 60 years; 71% males, 64% were diabetic, and 67% had a Hb A1C above 7% preoperatively. Around 7% of patients developed deep SSI. For patients that developed SSI, 63% had gram-negative bacteria. Hb A1C >7% was not found to be associated with an increased incidence of SSI. Conclusion Our results show that there is no apparent relationship between pre-operative Hgb A1C levels and SSI after cardiac surgery. Although we follow a comprehensive SSI perioperative bundle based on international guidelines that advocates using antibiotics to cover gram-positive organisms, it is interesting that the rate of gram-negative organisms in our patients' cohort is unexpectedly high. We believe that adjusting the perioperative antibiotic regimen based on local microbiological patterns seems to be a reasonable and easily achievable target to decrease the incidence of SSI.
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Affiliation(s)
- Hani N Mufti
- Cardiac Surgery, King Faisal Cardiac Center, King Abdullah Medical City, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mayar Jarad
- Medicine, Ibn Sina National College, Jeddah, SAU
| | | | | | | | - Imran Husain
- Cardiothoracic Surgery, The Golden Jubilee National Hospital, Glasgow, GBR
| | - Saad Albugami
- Cardiolgy, King Faisal Cardiac Center, King Abdullah Medical City, Jeddah, SAU
| | - Wael Elamin
- Cardiac Surgery, King Faisal Cardiac Center, King Abdulaziz Medical City, Jeddah, SAU
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