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Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting

W E Trick1, W E Scheckler, J I Tokars

  • 1Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA, USA. wbt9@cdc.gov

The Journal of Thoracic and Cardiovascular Surgery
|December 29, 1999
PubMed

Insights

Deep sternal site infection risk factors after coronary artery bypass grafting include delayed antibiotic use, high preoperative blood glucose, and staple skin closure. Avoiding these can prevent infection.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Disease Epidemiology
  • Surgical Site Infections

Background:

  • Deep sternal site infection (DSWI) is a serious complication following coronary artery bypass grafting (CABG).
  • Identifying modifiable risk factors is crucial for preventing DSWI in community hospital settings.

Purpose of the Study:

  • To identify independent risk factors associated with deep sternal site infection (DSWI) after coronary artery bypass grafting (CABG).
  • To compare the incidence of DSWI in a community hospital setting before and after a defined study period.

Main Methods:

  • A case-control study comparing patients with DSWI (cases) to those without (controls) after CABG.
  • Multivariable logistic regression analysis was used to identify independent risk factors for DSWI.
  • Prevalence of DSWI was compared between a pre-study and study period.

Main Results:

  • Deep sternal site infection (DSWI) incidence increased significantly from 0.7% pre-study to 1.7% during the study period (P=.04).
  • Independent risk factors identified were: cefuroxime administration ≥2 hours before incision (OR=5.0), diabetes mellitus with preoperative blood glucose ≥200 mg/dL (OR=10.2), and staple use for skin closure (OR=4.0).
  • Staple use was a significant risk factor specifically for patients with a normal body mass index.

Conclusions:

  • Optimizing the timing of antimicrobial prophylaxis is essential for preventing DSWI.
  • Effective control of preoperative blood glucose levels in diabetic patients is critical.
  • Avoiding staple use for skin closure in patients with a normal body mass index may reduce DSWI rates.
Abstract

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