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Study of cardiothoracic wound infection at St. Thomas' Hospital
Insights
Surgical site infections after open heart operations are linked to coronary artery bypass grafting (CABG). Leg wound infections may spread to sternal wounds, emphasizing skin disinfection and surgical technique over antibiotics.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Control
- Surgical Site Infections
Background:
- Wound infections pose a significant risk following open heart surgery.
- Coronary artery bypass grafting (CABG) involving saphenous vein harvesting has specific infection rates.
Purpose of the Study:
- To investigate the incidence and sources of wound infections after open heart operations.
- To identify risk factors associated with sternal wound infections in CABG patients.
Main Methods:
- Retrospective analysis of 433 open heart operations.
- Comparison of infection rates between patients with and without saphenous vein harvesting.
- Microbiological analysis of wound isolates.
Main Results:
- Overall wound infection rate of 14.3% in open heart surgery.
- Higher sternal infection rates (8.7%) in CABG patients compared to non-leg surgery patients (1.6%).
- Leg wound infections (12.9%) in CABG patients showed similar organisms to sternal infections, suggesting transfer via veins.
Conclusions:
- Leg wound contamination is a likely source of sternal wound infections in CABG.
- Pre-operative stay, diabetes, and re-operation are risk factors for sternal infections.
- Effective infection control relies on meticulous skin disinfection and surgical technique, rather than solely antibiotic prophylaxis.
Abstract:
Wound infection occurred after 14.3 per cent of 433 open heart operations. In 309, saphenous veins were harvested for coronary artery bypass grafting (CABG) and 8.7 per cent of sternal wounds and 12.9 per cent of leg wounds were infected. Only 1.6 per cent of the remaining 124 patients who had open heart operations without leg surgery suffered sternal wound infections. In the CABG group sternal infection was theatre-related and significantly associated with length of pre-operative stay, diabetes and re-operation. Similar organisms were isolated from both leg and sternal wounds which suggest that organisms were transferred from legs to sternum with the veins. No clinically relevant cross infection was demonstrated. Skin disinfection and surgical technique seem more important than antibiotic prophylaxis in the control of these infections.