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Preoperative carriage and postoperative same-species sternal wound infection after cardiac surgery

Jean-Michel Maillet1, Gregoire Oghina, Paul Le Besnerais

  • 1Department of Cardio Vascular and Thoracic Intensive Care, Centre Cardiologique du Nord, Saint-Denis, France. jm.maillet@ccncardio.com

Interactive Cardiovascular and Thoracic Surgery
|July 27, 2011
PubMed

Insights

Preoperative screening for Staphylococcus aureus (MSSA, MRSA) or resistant Gram-negative bacteria carriage did not reliably predict sternal wound infections after cardiac surgery. This approach is not recommended for guiding empirical antibiotic therapy.

Area of Science:

  • Infectious Diseases
  • Surgical Site Infections
  • Antimicrobial Resistance

Background:

  • Sternal wound infection (SWI) is a significant complication following cardiac surgery.
  • Identifying pathogens preoperatively could optimize antibiotic selection for SWI.
  • The role of preoperative carriage of specific bacteria in predicting SWI requires investigation.

Purpose of the Study:

  • To evaluate the diagnostic value of preoperative carriage of methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and multi-drug resistant Gram-negative bacilli (MDRGNB).
  • To determine if preoperative carriage predicts the same pathogens causing postoperative SWI.
  • To assess the utility of preoperative screening for guiding empirical antibiotic therapy in cardiac surgery patients.

Main Methods:

  • Retrospective study of 1895 patients undergoing elective cardiac surgery from April 2006 to December 2008.
  • Preoperative screening for MSSA, MRSA, and MDRGNB carriage using multisite sampling (nares, axillae, rectal) at admission.
  • Analysis of the association between preoperative carriage and the development of postoperative SWI, including ROC curve analysis for predictive value.

Main Results:

  • Of 1895 patients, 425 (22.4%) were colonized preoperatively.
  • Preoperative carriers had a higher incidence of SWI (11%) compared to non-carriers (5.5%, P<0.05).
  • The predictive ability (Area Under ROC Curve) for MSSA and MRSA SWI based on preoperative carriage was low (0.720 and 0.710, respectively). MDRGNB carriage data was insufficient for analysis.

Conclusions:

  • Preoperative carriage of MSSA is frequent, while MRSA and MDRGNB carriage are infrequent in cardiac surgery patients.
  • Preoperative bacterial carriage has a low ability to predict the same pathogen causing postoperative sternal wound infections.
  • Preoperative screening for MSSA, MRSA, or MDRGNB carriage should not be used to guide empirical antibiotic therapy for SWI.

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