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Related Experiment Videos

Wound infection in cardiothoracic surgery.

F C Wells, S W Newsom, C Rowlands

    Lancet (London, England)
    |May 28, 1983
    PubMed
    Summary

    Wound infections after cardiothoracic surgery, particularly coronary artery bypass surgery, are often caused by gram-negative bacteria from leg or perineal sites. Preoperative chlorhexidine baths did not reduce infection rates but may decrease leg wound inflammation.

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    Area of Science:

    • Surgical Infections
    • Cardiothoracic Surgery
    • Wound Care

    Background:

    • Postoperative wound inflammation and infection are significant concerns following cardiothoracic operations.
    • Routine open-heart surgery, thoracotomy, and coronary artery bypass surgery (CABG) carry distinct risks.
    • Understanding causative pathogens is crucial for effective prevention strategies.

    Purpose of the Study:

    • To monitor the incidence of wound inflammation and infection in patients undergoing various cardiothoracic procedures.
    • To identify the types of bacteria responsible for wound infections, especially sternal infections in CABG patients.
    • To evaluate the efficacy of preoperative chlorhexidine baths in reducing surgical site infections and inflammation.

    Main Methods:

    • Prospective monitoring of 454 patients for ten days post-operation.
    • Categorization of patients based on surgical type: open-heart (179), thoracotomy (100), and CABG (175).
    • Bacteriological analysis of wound infections, with specific attention to sternal and leg wounds in CABG patients.
    • Comparison of infection rates between patients receiving a preoperative chlorhexidine bath and those who did not.

    Main Results:

    • Overall inflammation/infection rates: intracardiac 12/2.3%, thoracotomy 12/1%, CABG 39/12% (sternal infection 7.5%).
    • Staphylococcal infection incidence was similar across all groups.
    • Elevated sternal wound infections in CABG patients were linked to gram-negative bacteria (Enterobacteria, Acinetobacter), also found in leg wounds.
    • Preoperative chlorhexidine baths did not affect infection rates but appeared to reduce leg wound inflammation.

    Conclusions:

    • Gram-negative bacteria, potentially originating from leg or perineal sites, are implicated in sternal wound infections following CABG.
    • The findings suggest a possible transmission route from leg/perineal areas to the sternal wound during surgery.
    • While chlorhexidine baths did not prevent infection, they may offer benefits in reducing superficial leg wound inflammation.

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