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J Thorac Cardiovasc Surg 2000;119:108-114
© 2000 Mosby, Inc.
SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE |
From the Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Ga,a and Saint Marys Hospital Medical Center, Madison, Wis.b
Address for reprints: William E. Trick, MD, Hospital Infections Program/CDC, 1600 Clifton Rd, MS E-69, Atlanta, GA 30333 (E-mail: wbt9{at}cdc.gov).
Objective: Our objective was to identify risk factors for deep sternal site infection after coronary artery bypass grafting at a community hospital.
Methods: We compared the prevalence of deep sternal site infection among patients having coronary artery bypass grafting during the study (January 1995–March 1998) and pre-study (January 1992–December 1994) periods. We compared any patient having a deep sternal site infection after coronary artery bypass graft surgery during the study period (case-patients) with randomly selected patients who had coronary artery bypass graft surgery but no deep sternal site infection during the same period (control-patients).
Results: Deep sternal site infections were significantly more common during the study than during the pre-study period (30/1796 [1.7%] vs 9/1232 [0.7%]; P = .04). Among 30 case-patients, 29 (97%) returned to the operating room for sternal debridement or rewiring, and 2 (7%) died. In multivariable analyses, cefuroxime receipt 2 hours or more before incision (odds ratio = 5.0), diabetes mellitus with a preoperative blood glucose level of 200 mg/dL or more (odds ratio = 10.2), and staple use for skin closure (odds ratio = 4.0) were independent risk factors for deep sternal site infection. Staple use was a risk factor only for patients with a normal body mass index.
Conclusions: Appropriate timing of antimicrobial prophylaxis, control of preoperative blood glucose levels, and avoidance of staple use in patients with a normal body mass index should prevent deep sternal site infection after coronary artery bypass graft operations.
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