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Enterobacter mediastinitis following cardiac surgery
Abstract:
Eight cases of sternal/mediastinal infection due to Enterobacter species were seen in postoperative cardiac patients during 1980 to 1981. The attack rate was 14.5% (8/55), compared to 3.7% (2/54) for an identical period in 1979 to 1980 (p less than 0.05). Cases varied in severity from fulminant, acute bacteremic infections (one death) to less severe wound infection. Late complications or recurrences were not seen. There was a hospital-wide increase, relative to all other gram-negative bacillary isolates, in Enterobacter laboratory isolations, but no increased rate of infection in any other specific surgical condition. No personnel, materials, or techniques were associated with the outbreak, and all but two environmental cultures were negative. Case-control analysis suggested that surgical complications and prophylactic cephalosporins were associated with infection. Prospectively, an additional 85 cardiac surgery patients had increased Enterobacter skin/wound colonization following perioperative prophylaxis with cephalosporin antibiotics. After introduction of barrier isolation and restriction of contacts no further mediastinitis occurred in 100 subsequent cardiac surgery patients. This study indicates that Enterobacter may be major pathogens causing post-cardiac-surgery infection not prevented by cephalosporin prophylaxis.
Insights
Enterobacter infections significantly increased in cardiac surgery patients, despite antibiotic use. This highlights the need for enhanced infection control measures beyond standard antibiotic prophylaxis to prevent sternal/mediastinal infections.
Area of Science:
- Infectious Diseases
- Surgical Site Infections
- Hospital Epidemiology
Background:
- Postoperative sternal/mediastinal infections pose a significant risk to cardiac surgery patients.
- Enterobacter species are increasingly recognized as potential pathogens in healthcare-associated infections.
Purpose of the Study:
- To investigate an outbreak of sternal/mediastinal infections caused by Enterobacter species in postoperative cardiac patients.
- To identify risk factors and contributing elements to the observed increase in Enterobacter infections.
Main Methods:
- Retrospective case-control analysis of infections occurring between 1980-1981 compared to 1979-1980.
- Prospective surveillance of Enterobacter colonization in cardiac surgery patients receiving cephalosporin prophylaxis.
- Implementation of barrier isolation and contact precautions for subsequent patient cohorts.
Main Results:
- An increased attack rate of sternal/mediastinal infections (14.5% vs. 3.7%) due to Enterobacter was observed.
- Surgical complications and prophylactic cephalosporins were identified as potential risk factors.
- Increased Enterobacter skin/wound colonization was noted post-cephalosporin prophylaxis.
- No further mediastinitis cases occurred after implementing enhanced infection control measures.
Conclusions:
- Enterobacter species can be significant pathogens in post-cardiac surgery infections.
- Cephalosporin prophylaxis alone may not prevent Enterobacter infections.
- Enhanced barrier isolation and contact precautions are crucial for controlling outbreaks of Enterobacter mediastinitis.