Abstract
Introduction: Post-sternotomy infection is a serious cause for morbidity and mortality after cardiac surgery. The goal of this study was to evaluate the impact of a microbial sealant on post-sternotomy infections in high risk patients undergoing cardiac surgery. Methods: Between January 2006 and July 2008 a total of 291 consecutive patients underwent cardiac surgery with a Fowler score of at least 10, which indicates high risk patients to develop surgical site infection (SSI). Patients were divided into a control group (n=132) receiving standard institutional preoperative care and a microbial sealant group (n=159) received additionally a microbial skin sealant. Pre- and peri-operative characteristics were examined for both groups. The clinical end-point of this study was freedom of post-sternotomy infection. Results: Follow up was 100% completed. The preoperative risk score of the control and the microbial sealant group were similar, respectively 15.5 ± 4.0 and 15.2 ± 3.8 (p=0.513). Comparing pre- and peri-operative characteristics of both groups, significant higher rates of carotid artery disease (p=0.022) and diabetics (p=0.046) were found in the microbial sealant group. All other pre- and peri-operative characteristics were similar for both groups. The clinical end-point however, showed a significant decrease of SSI in the microbial sealant group 2.5% (n=4) versus the control group 7.6% (n=10), (p=0.045). Conclusions: This study showed that the additional use of a microbial sealant to standard institutional preoperative preparation reduces statistically significant the risk for surgical site infection in high risk patients undergoing cardiac surgery.
Highlights
Post-sternotomy infection is a serious cause for morbidity and mortality after cardiac surgery
Mortality rates in patients infected with methicillin-resistant Staphylococcus aureus (MRSA) are as high as 74% [3]
In addition to the destructive impact on individual patients, there is a potential financial impact on treating Surgical site infection (SSI) starting from superficial wound infection, and major mediastinitis can even double the total cost for surgery [5]
Summary
Post-sternotomy infection is a serious cause for morbidity and mortality after cardiac surgery. Surgical site infection (SSI) is a serious complication after cardiac surgery. Mortality rates in patients infected with methicillin-resistant Staphylococcus aureus (MRSA) are as high as 74% [3]. Mekonto-Dessap et al [4] examined the mortality rate of patients with post-sternotomy mediastinitis, at 30 days postoperatively, by MRSA and MethicillinSusceptible Staphylococcus aureus respectively, 40% and 15% [4]. In 41 patients reassessed 3 years after surgical treatment, the mortality rates were 74% and 21% respectively. In addition to the destructive impact on individual patients, there is a potential financial impact on treating SSI starting from superficial wound infection, and major mediastinitis can even double the total cost for surgery [5]
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