Related Experiment Videos
Aspergillus fumigatus sternal wound infections in patients undergoing open heart surgery
H M Richet1, M M McNeil, B J Davis
1Epidemiology Branch, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
Insights
Six patients developed Aspergillus fumigatus sternal wound infections after open heart surgery. Chronic lung disease was the primary risk factor, suggesting patients with this condition and respiratory colonization are at higher risk.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Surgical Site Infections
Background:
- Sternal wound infections following open heart surgery are serious complications.
- Aspergillus fumigatus is an opportunistic pathogen that can cause severe infections.
Purpose of the Study:
- To investigate the risk factors and characteristics of sternal wound infections caused by Aspergillus fumigatus after open heart surgery.
- To identify predictors for these rare but severe infections.
Main Methods:
- Retrospective case series of six patients with Aspergillus fumigatus sternal wound infections.
- Univariate and multivariate analyses to identify risk factors.
- Review of patient characteristics and hospital trends.
- Investigation for environmental sources and assessment of A. fumigatus colonization rates.
Main Results:
- Chronic lung disease was the only independent risk factor for Aspergillus fumigatus sternal wound infection.
- No surgical or operating room factors were associated with infection.
- A trend towards older and sicker patients undergoing open heart surgery was observed.
- Aspergillus fumigatus was isolated from bronchial washings of one patient, and colonization rates matched infection rates.
Conclusions:
- Patients with chronic lung disease and respiratory colonization with Aspergillus fumigatus are at increased risk for sternal wound infections post-open heart surgery.
- No environmental source was identified, suggesting endogenous factors may play a role.
Abstract:
During a 21-month period (July 1986-April 1988), six patients who underwent open heart surgery at Holston Valley Hospital and Medical Center in Kingsport, Tennessee, developed sternal would infections caused by Aspergillus fumigatus. All patients required sternectomy, reconstructive surgery, and long term amphotericin B therapy; no patient died. By univariate analysis, the following were significantly associated with A. fumigatus sternal would infection: chronic lung disease, a recent history of pneumonia, a greater mean number of admission diagnoses, and a particular surgeon. However, multivariate analysis identified chronic lung disease as the only independent risk factor and the best predictor of A. fumigatus sternal wound infections. No factors related to the surgical procedure or operating room personnel were associated with infection. A review of the characteristics of the patients undergoing open heart surgery showed that since 1985, there had been a trend for these patients at Holston Valley Hospital and Medical Center to be older and sicker, which may have contributed to the occurrence of infections never observed before. Despite an extensive investigation, no environmental source for A. fumigatus was identified. A. fumigatus, however, grew from the bronchial washing of one patient at the time the sternal wound infection was diagnosed, and a prospective study showed that the rate of A. fumigatus colonization among open heart surgery patients was the same as the rate of sternal wound infections caused by A. fumigatus. These data suggest that patients with chronic lung disease and respiratory colonization with A. fumigatus are at increased risk for A. fumigatus sternal wound infections after open heart surgery.