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Mediastinitis following coronary artery bypass surgery: a 3-year review
R Gaynes1, R Marosok, J Mowry-Hanley
1Department of Internal Medicine, University of Michigan Hospitals, Ann Arbor.
Abstract:
Twenty cases of mediastinitis after coronary artery bypass graft operations in 1985-1987 were reviewed to determine risk factors. Two distinct clusters with a methicillin-resistant Staphylococcus aureus (MRSA) strain occurred in 1986. One resident was exposed to six cases but to only 5 of 24 controls (P less than .008). Cultures of his nares in January and November 1986 revealed the same MRSA strain as that of the cases. An attempt to eradicate the resident's nasal carriage of MRSA in January 1986 failed; eradication of his carrier state was achieved only after treatment with mupirocin. In a case-control study examining patients exposed to the resident, a prolonged duration of surgery (P less than .05) and a preoperative albumin level of less than 3.0 g/dl (P less than .009) were associated with mediastinitis with this MRSA. For the other 14 mediastinitis patients, who were not exposed to the resident, a preoperative albumin level of less than 3.0 g/dl was also a risk factor (8/14 cases vs. 8/43 controls, P less than .009). Thus, this study suggests that it is important to follow MRSA disseminators and to recognize that preoperative serum albumin levels are a risk factor for mediastinitis.
Insights
Healthcare workers can carry methicillin-resistant Staphylococcus aureus (MRSA), a cause of post-cardiac surgery mediastinitis. Low preoperative albumin levels are a significant risk factor for this infection.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Epidemiology
Background:
- Mediastinitis is a serious complication following coronary artery bypass graft (CABG) operations.
- Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant pathogen in healthcare-associated infections.
Purpose of the Study:
- To identify risk factors for mediastinitis after CABG operations.
- To investigate the role of a healthcare worker as a potential MRSA disseminator.
Main Methods:
- Retrospective review of 20 mediastinitis cases post-CABG.
- Case-control study to assess risk factors including healthcare worker exposure.
- Microbiological cultures and strain typing of MRSA.
Main Results:
- Two clusters of MRSA mediastinitis were identified, linked to a single resident carrier.
- Prolonged surgery duration and low preoperative albumin (<3.0 g/dl) were risk factors for MRSA mediastinitis in exposed patients.
- Low preoperative albumin was also a risk factor for mediastinitis in patients not exposed to the identified carrier.
Conclusions:
- Healthcare workers can act as reservoirs for MRSA, contributing to surgical site infections.
- Preoperative hypoalbuminemia is a critical risk factor for developing mediastinitis after CABG.
- Monitoring and managing MRSA carriers in healthcare settings is crucial to prevent infection outbreaks.
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