Graf Karolin, Sohr Dorit, Haverich Axel, Kühn Christian, Gastmeier Petra, Chaberny Iris F
Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, D-30625 Hannover, Germany.
Interact Cardiovasc Thorac Surg. 2009 Aug;9(2):282-6. doi: 10.1510/icvts.2009.205286. Epub 2009 May 5.
When we noticed an increasing incidence of deep sternal surgical site infections (DSSI), a bundle of interdisciplinary infection control measures was initiated in order to prevent further cases of DSSI. Adherence to infection control measures was re-inforced, which included (1) methicillin-resistant Staphylococcus aureus (MRSA) screening, (2) bacterial decolonisation measures, (3) hair clipping instead of shaving, (4) education, (5) good stewardship for antibiotic prophylaxis, (6) change of surgical gloves after sternotomy and after sternal wiring, (7) new bandage techniques, (8) leaving the wound primarily covered for at least 48 h. We checked for potential risk factors in a case-control study (120 patients each) by multivariate analysis. A significant decrease of DSSI from 3.61% (CI 95: 2.98-4.35) down to 1.83% (CI 95: 1.08-2.90) occurred. Independent significant risk factors for DSSI were age >68 years (OR=2.47; CI 95: 1.33-4.60), diabetes mellitus (OR=4.84; CI 95: 2.25-10.4), and intra-operative blood glucose level >8 mmol/l (OR=2.27; CI 95: 1.17-4.42). Protective factors were preoperative antibiotic prophylaxis (OR=0.31; CI 95: 0.13-0.70) and extubation on the day of surgery (OR=0.25; CI 95: 0.11-0.55). Close co-operation between clinical physicians and the infection control team significantly reduced the rate of DSSI. Thus, cardiac surgeons should know the local baseline DSSI rate, e.g. by surveillance, and should be aware of the risk factors for DSSI cases.
当我们注意到深部胸骨手术部位感染（DSSI）的发生率不断上升时，启动了一系列跨学科感染控制措施，以防止更多DSSI病例的出现。强化了对感染控制措施的遵守，这些措施包括：（1）耐甲氧西林金黄色葡萄球菌（MRSA）筛查；（2）细菌去定植措施；（3）剪发而非剃毛；（4）教育；（5）合理使用抗生素预防；（6）胸骨切开术后和胸骨固定后更换手术手套；（7）新的包扎技术；（8）伤口最初至少覆盖48小时。我们通过多变量分析在一项病例对照研究（每组120例患者）中检查了潜在风险因素。DSSI发生率从3.61%（95%CI：2.98 - 4.35）显著下降至1.83%（95%CI：1.08 - 2.90）。DSSI的独立显著风险因素为年龄>68岁（OR = 2.47；95%CI：1.33 - 4.60）、糖尿病（OR = 4.84；95%CI：2.25 - 10.4）以及术中血糖水平>8 mmol/L（OR = 2.27；95%CI：1.17 - 4.42）。保护因素为术前抗生素预防（OR = 0.31；95%CI：0.13 - 0.70）和手术当天拔管（OR = 0.25；95%CI：0.11 - 0.55）。临床医生与感染控制团队之间的密切合作显著降低了DSSI发生率。因此，心脏外科医生应通过监测等方式了解当地DSSI的基线发生率，并应知晓DSSI病例的风险因素。
