Department of Infectious Diseases and Clinical Microbiology, Acibadem Adana Hospital, Adana, Turkey.
Department of Cardiovascular Surgery, Acibadem Adana Hospital, Adana, Turkey.
Ulus Travma Acil Cerrahi Derg. 2022 Jan;28(2):180-186. doi: 10.14744/tjtes.2020.13546.
In this study, we aimed to evaluate mediastinitis cases developed after isolated coronary artery bypass graft surgery performed by median sternotomy to determine the causative microorganisms, risk factors, and clinical features.
Between March 2009 and December 2018, a total of 44 patients (32 males and 12 females; mean age 62.84±6.951 years; range, 46-78 years) who underwent isolated coronary artery bypass grafting surgery with median sternotomy and developed mediastinitis postoperatively were included in the studying our cardiovascular surgery (CVS) department. Patients demographic information, comorbidities, habits, pre-operative hospital stay, elective or emergency surgery, perioperative internal mammary artery use, perioperative blood or blood product, operation and cardiopulmonary bypass times, suitability of antibiotic prophylaxis, medical and surgical treatment, clinical data, and laboratory results were retrospectively analyzed. Purulent discharge cultures obtained directly from the mediastinal space and microbiological examination notes made from the material obtained from the surgical site or surgical repair were recorded.
In isolated coronary artery bypass grafting surgery performed over a period of approximately 10 years, the rate of mediastinitis was 1%. There was no statistically significant difference between patients with and without mediastinitis in terms of age, sex, smoking habits, duration of operation and cardiopulmonary bypass, and intraoperative blood transfusion. The presence of diabetes mellitus and high mean body mass index was significantly higher in patients with mediastinitis compared to those without. Mediastinitis was diagnosed in 38 (86.3%) patients in the 1st month, 5 (11.3%) in the first 3 months, and 1 (2.2%) in the 1st year. Twenty-five (56.9%) Gram-positive bacteria, 13 (29.6%) Gram-negative bacteria, and 1 (2.3%) fungi were the microorganisms grown in purulent discharge cultures. Pathogen microorganisms could not be produced in 5 (11.4%) cases. The three most commonly isolated agents were methicillin-resistant coagulase-negative staphylococci (MRCNS) (50%), Escherichia coli (9.1%), and Klebsiella pneumoniae (6.8%).
Attention should be paid to surgical site infection in patients undergoing CVS. Following discharge, follow-up is important and empirical treatment should be determined by considering the presence of MRCNS as the leading infectious agent in our hospital when infection occurs.
本研究旨在评估经正中开胸行单纯冠状动脉旁路移植术（CABG）后发生的纵隔炎病例，以确定其致病微生物、危险因素和临床特征。
2009 年 3 月至 2018 年 12 月，共有 44 例（男 32 例，女 12 例；平均年龄 62.84±6.951 岁；年龄范围 46-78 岁）患者接受正中开胸行单纯 CABG 手术后并发纵隔炎，均来自我院心血管外科（CVS）。回顾性分析患者的人口统计学信息、合并症、习惯、术前住院时间、择期或急诊手术、围术期内乳动脉使用、围术期血制品或血液制品使用、手术和体外循环时间、抗生素预防的适宜性、医疗和手术治疗、临床数据和实验室结果。记录直接从纵隔空间获得的脓性分泌物培养结果以及从手术部位或手术修复处获得的微生物检查记录。
在大约 10 年的单纯 CABG 手术中，纵隔炎的发生率为 1%。在有和无纵隔炎的患者中，年龄、性别、吸烟习惯、手术和体外循环时间以及术中输血无统计学差异。患有糖尿病和高平均体重指数的患者在有和无纵隔炎的患者中显著更高。38 例（86.3%）患者在术后 1 个月内、5 例（11.3%）在术后 3 个月内、1 例（2.2%）在术后 1 年内诊断为纵隔炎。脓性分泌物培养中生长的微生物 25 例（56.9%）为革兰阳性菌，13 例（29.6%）为革兰阴性菌，1 例（2.3%）为真菌。5 例（11.4%）无法产生病原体微生物。最常分离的三种药物是耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）（50%）、大肠杆菌（9.1%）和肺炎克雷伯菌（6.8%）。
CVS 术后应注意手术部位感染。出院后，随访很重要，当发生感染时，应考虑我院以 MRCNS 为主要感染因子，确定经验性治疗。
