Ma Jia-Gui, An Jian-Xiong
Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China.
J Thorac Dis. 2018 Jan;10(1):377-387. doi: 10.21037/jtd.2017.12.109.
Deep sternal wound infection (DSWI) is a severe complication following cardiac surgery. We compared epidemiology, clinical features, and microbiology of three types of DSWI and examined the antibiotic resistance in DSWI patients.
From 2011 to 2015, 170 adult post-cardiac surgery DSWI patients were recruited for this study and underwent the pectoralis major muscle flap transposition in our department.
Of 170 adult patients with DSWI (mean age of 54 years), the majority (99 patients, 58.2%) had type II DSWI. The three types of DSWI patients showed significant differences in terms of gender, smoking history, chronic obstructive pulmonary disease (COPD), length of intensive care unit (ICU) stay, and hospitalization cost (P<0.05). The most common symptoms of DSWI patients were fever and wound dehiscence accompanied by purulent secretions. Types I and II DSWI were more frequently associated with hypoproteinemia and high leucocyte count (P<0.05). Microbiological diagnosis was available for 77 of 170 patients (45.3%). Of 157 pathogens detected, 87 (55.4%) species of gram negative bacilli were identified and most commonly were (25.5%) and methicillin-susceptible (20.4%). However, no statistically significant microbiological differences among the three DSWI types were observed (P>0.05). Notably, isolates showed 100% resistance to cefazolin and cefuroxime. Meanwhile, the resistance rate of isolates to commonly used antibiotics was greater than 70%, while resistance rates of staphylococcus to penicillin-G were 100% and to clindamycin were over 70%. No isolates were resistant to vancomycin, linezolid, and tigecycline.
Three types of DSWI exhibit differences in epidemiology and clinical features. and are the most common pathogens in DSWI patients and antibiotic resistance is a serious concern in these patients. Therefore, prevention and treatment of DSWI should be closely tailored to clinical features, local microbiological characteristics, and resistance patterns of commonly encountered pathogens.
深部胸骨伤口感染（DSWI）是心脏手术后的一种严重并发症。我们比较了三种类型DSWI的流行病学、临床特征和微生物学，并研究了DSWI患者的抗生素耐药性。
2011年至2015年，招募了170例心脏手术后发生DSWI的成年患者进行本研究，并在我科接受了胸大肌肌瓣转移术。
170例成年DSWI患者（平均年龄54岁）中，大多数（99例，58.2%）为II型DSWI。三种类型的DSWI患者在性别、吸烟史、慢性阻塞性肺疾病（COPD）、重症监护病房（ICU）住院时间和住院费用方面存在显著差异（P<0.05）。DSWI患者最常见的症状是发热和伤口裂开并伴有脓性分泌物。I型和II型DSWI更常与低蛋白血症和白细胞计数升高有关（P<0.05）。170例患者中有77例（45.3%）获得了微生物学诊断。在检测到的157种病原体中，鉴定出87种（55.4%）革兰氏阴性杆菌，最常见的是（25.5%）和对甲氧西林敏感的（20.4%）。然而，三种DSWI类型之间未观察到统计学上显著的微生物学差异（P>0.05）。值得注意的是，分离株对头孢唑林和头孢呋辛显示出100%的耐药性。同时，分离株对常用抗生素的耐药率大于70%，而葡萄球菌对青霉素G的耐药率为100%，对克林霉素的耐药率超过70%。没有分离株对万古霉素、利奈唑胺和替加环素耐药。
三种类型的DSWI在流行病学和临床特征上存在差异。和是DSWI患者中最常见的病原体，抗生素耐药性是这些患者的一个严重问题。因此，DSWI的预防和治疗应紧密结合临床特征、当地微生物学特征和常见病原体的耐药模式。
