心脏直视手术后凝固酶阴性葡萄球菌所致的胸骨伤口感染

Coagulase-negative staphylococcal sternal wound infections after open heart operations.

作者信息

Mossad S B, Serkey J M, Longworth D L, Cosgrove D M, Gordon S M

机构信息

Department of Infectious Diseases, Cleveland Clinic Foundation, OH 44195-5066, USA.

出版信息

Ann Thorac Surg. 1997 Feb;63(2):395-401. doi: 10.1016/s0003-4975(96)00834-x.

DOI:10.1016/s0003-4975(96)00834-x

PMID:9033307

Abstract

BACKGROUND

Coagulase-negative staphylococci are commonly isolated from wounds of patients after median sternotomy; however, the epidemiology of these infections is poorly described and the morbidity, mortality, and cost of care remain undefined.

METHODS

Retrospectively, we studied all patients with sternal wound infections attributable to coagulase-negative staphylococci after 22,180 open heart procedures performed at the Cleveland Clinic between January 1, 1988, and December 31, 1994 (84 months). In an assessment of potential risk factors for sternal wound infections caused by coagulase-negative staphylococci, 17 patients with coagulase-negative staphylococcal sternal wound infections were compared with 29 patients who underwent open heart operations without subsequent sternal wound infections, as well as with another 22 patients in whom sternal wound infections attributable to other pathogens developed.

RESULTS

A total of 436 sternal wound infections were identified (19 per 1,000 procedures), of which 100 (23%) were attributable to coagulase-negative staphylococci (4.5 per 1,000). Fifty-six percent of coagulase-negative staphylococcal sternal wound infections were superficial, 27% were deep, and 17% represented mediastinitis; 14% of patients had a concomitant secondary bloodstream infection. Ninety-two percent of coagulase-negative staphylococcal isolates were methicillin resistant. The mean interval from operation to onset of infection was 24 days (range, 4 to 388 days), and most patients had purulent discharge from the chest wound, fever, and leukocytosis. Adverse outcomes included reexploration (39%), flap operation (12%), and sternectomy (5%); 89% required parenteral antibiotics for a mean of 22 days. This resulted in 2,600 additional hospital days, with an average additional direct cost per case of $20,000. In both case-control studies, insulin-dependent diabetes mellitus was the only risk factor significantly associated with sternal wound infections attributable to coagulase-negative staphylococci (p value = 0.02 by two-tailed Fisher's exact test).

CONCLUSIONS

Sternal wound infections attributable to coagulase-negative staphylococci had a substantial impact on cardiothoracic surgery-related morbidity.

摘要

背景

凝固酶阴性葡萄球菌通常从正中开胸术后患者的伤口中分离得到；然而，这些感染的流行病学情况描述甚少，其发病率、死亡率及护理费用仍不明确。

方法

我们回顾性研究了1988年1月1日至1994年12月31日（84个月）期间在克利夫兰诊所进行的22180例心脏直视手术后所有因凝固酶阴性葡萄球菌导致胸骨伤口感染的患者。在评估凝固酶阴性葡萄球菌引起胸骨伤口感染的潜在危险因素时，将17例凝固酶阴性葡萄球菌性胸骨伤口感染患者与29例接受心脏直视手术但随后未发生胸骨伤口感染的患者以及另外22例发生由其他病原体引起的胸骨伤口感染的患者进行了比较。

结果

共识别出436例胸骨伤口感染（每1000例手术中有19例），其中100例（23%）归因于凝固酶阴性葡萄球菌（每1000例中有4.5例）。凝固酶阴性葡萄球菌性胸骨伤口感染中56%为表浅感染，27%为深部感染，17%为纵隔炎；14%的患者伴有继发性血流感染。92%的凝固酶阴性葡萄球菌分离株对甲氧西林耐药。从手术到感染发作的平均间隔时间为24天（范围为4至388天），大多数患者胸部伤口有脓性分泌物、发热和白细胞增多。不良结局包括再次手术探查（39%）、皮瓣手术（12%）和胸骨切除术（5%）；89%的患者需要胃肠外使用抗生素，平均使用22天。这导致额外住院天数达2600天，每例平均额外直接费用为20000美元。在两项病例对照研究中，胰岛素依赖型糖尿病是与凝固酶阴性葡萄球菌引起的胸骨伤口感染显著相关的唯一危险因素（双侧Fisher精确检验p值 = 0.02）。