INSERM, IAME, UMR 1137, Paris, France; Univeristé Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Infection Control Unit, Paris, France.
INSERM, IAME, UMR 1137, Paris, France; Univeristé Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Infectious Diseases Department, Paris, France.
Clin Microbiol Infect. 2018 Mar;24(3):283-288. doi: 10.1016/j.cmi.2017.07.004. Epub 2017 Jul 8.
To determine the incidence, microbiology and risk factors for sternal wound infection (SWI) with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) following cardiac surgery.
We performed a retrospective analysis between January 2006 and December 2015 of prospective surveillance of a cohort of patients with cardiac surgery at a single centre (Paris, France). SWI was defined as the need for reoperation due to sternal infection. All patients with an initial surgery under extracorporeal circulation and diagnosed with an SWI caused by Enterobacteriaceae isolates were included. We compared patients infected with at least one ESBL-PE with those with SWI due to other Enterobacteriaceae by logistic regression analysis.
Of the 11 167 patients who underwent cardiac surgery, 412 (3.7%) developed SWI, among which Enterobacteriaceae were isolated in 150 patients (36.5%), including 29 ESBL-PE. The main Enterobacteriaceae (n = 171) were Escherichia coli in 49 patients (29%) and Enterobacter cloacae in 26 (15%). Risk factors for SWI with ESBL-PE in the multivariate logistic regression were previous intensive care unit admission during the preceding 6 months (adjusted odds ratio (aOR) 12.2; 95% CI 3.3-44.8), postoperative intensive care unit stay before surgery for SWI longer than 5 days (aOR 4.6; 95% CI 1.7-11.9) and being born outside France (aOR 3.2; 95% CI 1.2-8.3).
Our results suggest that SWI due to ESBL-PE was associated with preoperative and postoperative unstable state, requiring an intensive care unit stay longer than the usual 24 or 48 postoperative hours, whereas being born outside France may indicate ESBL-PE carriage before hospital admission.
确定心脏手术后产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）引起的胸骨伤口感染（SWI）的发生率、微生物学和危险因素。
我们对 2006 年 1 月至 2015 年 12 月期间在法国巴黎一家单中心进行的心脏手术队列前瞻性监测进行了回顾性分析。SWI 定义为需要因胸骨感染而再次手术。所有接受体外循环初始手术并诊断为肠杆菌科分离株引起的 SWI 的患者均被纳入研究。我们通过逻辑回归分析比较了感染至少一种 ESBL-PE 的患者与因其他肠杆菌科引起的 SWI 患者。
在接受心脏手术的 11 167 例患者中，有 412 例（3.7%）发生 SWI，其中 150 例（36.5%）分离出肠杆菌科，包括 29 例 ESBL-PE。主要肠杆菌科（n=171）包括 49 例大肠埃希菌（29%）和 26 例阴沟肠杆菌（15%）。多变量逻辑回归分析显示，ESBL-PE 引起 SWI 的危险因素包括：6 个月前在重症监护病房接受过治疗（校正优势比[aOR] 12.2；95%可信区间[CI] 3.3-44.8）、SWI 术前在重症监护病房的术后停留时间超过 5 天（aOR 4.6；95% CI 1.7-11.9）和出生在法国境外（aOR 3.2；95% CI 1.2-8.3）。
我们的结果表明，ESBL-PE 引起的 SWI 与术前和术后不稳定状态有关，需要在重症监护病房停留超过通常的术后 24 或 48 小时，而出生在法国境外可能表明在住院前携带 ESBL-PE。
