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Enterobacter mediastinitis following cardiac surgery.

D L Palmer, J N Kuritsky, S C Lapham

    Infection Control : IC
    |March 1, 1985
    PubMed
    Summary

    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.

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    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.

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  • 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.