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Poststernotomy mediastinitis due to methicillin-resistant Staphylococcus aureus endemic in a hospital
Cheng-Hsin Lin1, Ron-Bin Hsu, Shan-Chwen Chang
1Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Abstract:
The objective of this study was to determine the incidence of and risk factors for poststernotomy mediastinitis (PSM) due to methicillin-resistant Staphylococcus aureus (MRSA) infection in a hospital in which MRSA was endemic. A retrospective case-control study of patients with PSM after cardiac surgery during January 1997 through July 2002 was conducted. The incidence of PSM was 1.01% (48 of 4746 patients), and 31 episodes (64.6%) were due to MRSA infection. We analyzed the findings for 48 case and 65 control patients. Univariate analysis revealed that the risk factors for PSM were previous hospitalization, resternotomy, chronic renal insufficiency, longer operation time, postoperative heart failure, postoperative renal failure, and reoperation for bleeding. Multivariate analysis revealed that the independent risk factors for PSM were previous hospitalization and reoperation for bleeding. Previous hospitalization was the only significant risk factor for PSM due to MRSA infection. The hospital mortality rate associated with PSM was 41.7%, and there was a higher mortality rate associated with PSM due to MRSA infection.
Insights
Previous hospitalization is a key risk factor for poststernotomy mediastinitis (PSM), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA). This finding is crucial for preventing serious cardiac surgery complications.
Area of Science:
- Infectious Diseases
- Cardiovascular Surgery
- Hospital Epidemiology
Background:
- Poststernotomy mediastinitis (PSM) is a serious complication following cardiac surgery.
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant challenge in endemic hospital settings.
- Understanding risk factors for PSM is critical for patient outcomes.
Purpose of the Study:
- To determine the incidence of PSM in a hospital with endemic MRSA.
- To identify risk factors associated with PSM, specifically MRSA-related infections.
- To analyze the impact of PSM on hospital mortality.
Main Methods:
- Retrospective case-control study design.
- Inclusion of patients who underwent cardiac surgery between January 1997 and July 2002.
- Analysis of 48 PSM cases and 65 control patients.
Main Results:
- The overall incidence of PSM was 1.01%.
- MRSA accounted for 64.6% of PSM episodes.
- Independent risk factors for PSM included previous hospitalization and reoperation for bleeding. Previous hospitalization was the sole significant risk factor for MRSA-PSM.
- Hospital mortality for PSM was 41.7%, with higher rates for MRSA-PSM.
Conclusions:
- Previous hospitalization is a significant risk factor for PSM, especially MRSA-PSM.
- Reoperation for bleeding is also an independent risk factor for PSM.
- PSM, particularly due to MRSA, is associated with high hospital mortality, emphasizing the need for targeted prevention strategies.