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Increase in the Rate of Sternal Surgical Site Infection After Coronary Artery Bypass Graft: A Marker of Higher Severity of Illness

Published online by Cambridge University Press:  02 January 2015

Mohamad G. Fakih ,
Mamta Sharma ,
Riad Khatib ,
Dorine Berriel-Cass ,
Susan Meisner ,
Steven Harrington  and
Louis Saravolatz
Mohamad G. Fakih*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Michigan Infection Control Department, Michigan St. John Hospital and Medical Center, Gross Pointe Woods, and the, Wayne State University School of Medicine, Detroit, Michigan
Mamta Sharma
Affiliation:
Division of Infectious Diseases, Department of Medicine, Michigan St. John Hospital and Medical Center, Gross Pointe Woods, and the, Wayne State University School of Medicine, Detroit, Michigan
Riad Khatib
Affiliation:
Division of Infectious Diseases, Department of Medicine, Michigan St. John Hospital and Medical Center, Gross Pointe Woods, and the, Wayne State University School of Medicine, Detroit, Michigan
Dorine Berriel-Cass
Affiliation:
Infection Control Department, Michigan
Susan Meisner
Affiliation:
Department of Cardiothoracic Surgery, Michigan
Steven Harrington
Affiliation:
Department of Cardiothoracic Surgery, Michigan
Louis Saravolatz
Affiliation:
Division of Infectious Diseases, Department of Medicine, Michigan St. John Hospital and Medical Center, Gross Pointe Woods, and the, Wayne State University School of Medicine, Detroit, Michigan
*
Division of Infectious Diseases, Dept. of Medicine, St. John Hospital and Medical Center, 19251 Mack Ave., Ste. 340, Grosse Pointe Woods, MI 48236 (mohamad.fakih@stjohn.org)
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Abstract

Objective.

To evaluate factors related to a gradual rise in sternal surgical site infection (SSI) rates.

Design.

Retrospective cohort study.

Setting.

A 608-bed, tertiary care teaching hospital.

Patients.

All patients who underwent coronary artery bypass graft (CABG) from January 2000 through September 2004.

Results.

Of 3,578 patients who underwent CABG, 144 (4%) had sternal SSI. There was an increase in infection rate, with a marked reduction in the number of operations per year. The percentage of patients with peripheral vascular disease increased from 12% to 24.3% (P < .001), and the percentage with congestive heart failure increased from 17% to 22% (P < .001). Between 2002 and 2004, the mean duration of surgery increased from 233 to 290 minutes (P < .001), the percentage of patients with a National Nosocomial Infections Surveillance System (NNIS) risk index of 2 increased from 14.3% to 38% (P < .001), and the percentage of patients with a postoperative stay in the intensive care unit of greater than 72 hours increased from 29% to 40.6% (P < .001). Multivariate analysis showed diabetes mellitus, peripheral vascular disease, obesity, duration of surgery, and postoperative stay in the intensive care unit of greater than 72 hours to be independently associated with infection.

Conclusions.

An increase in infection in the CABG population not associated with an outbreak may be a reflection of a change in the severity of illness. Preoperative, intraoperative, and postoperative markers for increased infection risk may be used, in addition to the NNIS risk index, to assess the patient population risk.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 655 - 660
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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