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Eur J Cardiothorac Surg 2000;17:154-160
© 2000 Elsevier Science NL

The endogenous pathway is a major route for deep sternal wound infection

Heinz G. Jakoba, Marianne Borneff-Lippb, Alfons Bachc, Stefanie von Pücklerc, Jürgen Windelerd, Hans-Günther Sonntagc, Siegfried Hagla

a Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
b Institute of Hygiene, Medical Faculty, University of Halle Wittenberg, J.-A.-Segner-Strasse 12, D-06097 Halle, Germany
c Department of Hygiene and Medical Microbiology, University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
d Institute of Biometrics, University of Heidelberg, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany

Corresponding author. Department of Thoracic and Cardiovascular Surgery, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany. Tel.: +49-201-723-3151; fax: +49-201-723-5931
e-mail: heinz.jakob{at}uni-essen.de

Objective: Deep wound infections pose an increasing problem in cardiac surgery patients. Prospective infection monitoring is thus a means of identifying possible risk factors. Methods: Within a period of 5 months, a total of 376 adult patients, 260 men and 116 women, with a mean age of 62.6 years (range 18–88), underwent coronary bypass grafting (n=281) or other cardiac surgery procedures (n=95). Nasal cultures were taken preoperatively from every patient, as well as cultures of the wound during surgery and when dressings were changed thereafter. In addition, nasal cultures were taken from all the medical and nursing staff. To differentiate endogenous and exogenous infection pathways, DNA fingerprint analysis was performed. Results: A total of 38 patients (10.1%) developed a wound infection, in 14 patients this happened to be a deep wound infection, in 24 patients a superficial one. Five sternal wound infections were associated with mediastinitis (1.3%). The occurrence of a wound infection overall resulted in prolonged hospitalization (29.4±24 vs. 11.9±6.9 days, P=0.001), but not in increased hospital mortality (4.4% vs. 3.9%). Obesity, diabetes mellitus and nasal carriage of Staphylococcus aureus proved to be independent risk factors with an odds ratio of 2.07, 2.26 and 2.28, respectively. In all but one of the sternal colonizations with S. aureus, DNA fingerprint analysis demonstrated an identical pattern of S. aureus from the patient's nose and sternum, indicating an endogenous infection pathway. Conclusions: The determination of the endogenous pathway for severe wound infection makes prevention possible by means of preoperative local S. aureus eradication.

Key Words: Deep sternal wound infection • Pulsed-field gel electrophoresis • DNA fingerprint analysis • Risk factors




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