scholarly journals Antimicrobial Prophylaxis for Patients Undergoing Cardiac Surgery: Intraoperative Cefazolin Concentrations and Sternal Wound Infections

2018 ◽  
Vol 62 (11) ◽  
Author(s):  
Sheryl A. Zelenitsky ◽  
Divna Calic ◽  
Rakesh C. Arora ◽  
Hilary P. Grocott ◽  
Ted M. Lakowski ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Wound Closure ◽  
Antimicrobial Prophylaxis ◽  
Wound Infections ◽  
Site Infection ◽  
Risk Of Infection ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Dosing Strategies ◽  
Sternal Wound Infections

ABSTRACTThis study characterizes the pharmacodynamics of antimicrobial prophylaxis and sternal wound infections following cardiac surgery. Duration of surgery and cefazolin plasma concentration during wound closure were independently associated with surgical site infection at 30 days. Furthermore, a duration of surgery of >346 min and a total cefazolin closure concentration of <104 mg/liter were significant thresholds for an increased risk of infection. This study provides new data that informs dosing strategies for effective antimicrobial prophylaxis (AP) in patients undergoing cardiac surgery with cardiopulmonary bypass.

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients

2017 ◽  
Vol 8 (4) ◽  
pp. 453-459 ◽  
Author(s):  
Cathy Woodward ◽  
Richard Taylor ◽  
Minnette Son ◽  
Roozbeh Taeed ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Wound Infections ◽  
Improvement Project ◽  
Sternal Closure ◽  
Increased Risk ◽  
Delayed Sternal Closure ◽  
Sternal Wound Infections

Background: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Methods: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Results: Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. Conclusion: A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

scholarly journals 1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S577
Author(s):  
Thomas Holowka ◽  
Harry Cheung ◽  
Maricar F Malinis ◽  
Sarah Perreault ◽  
Iris Isufi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Antimicrobial Prophylaxis ◽  
Hematologic Malignancy ◽  
Invasive Fungal Infections ◽  
Risk Of Infection ◽  
Factors Associated ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p &lt; 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p &lt; 0.001), neutropenia (OR 3.6, p &lt; 0.01), lymphopenia (OR 2.4, p &lt; 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p &lt; 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

Aspergillus flavus costochondritis following coronary artery bypass grafting: a case report and a brief review of literature

2021 ◽  
pp. 021849232098845
Author(s):  
Aamir Mohammad ◽  
Santhosh Regini Benjamin ◽  
Sameer Mallampati ◽  
Birla Roy Gnanamuthu ◽  
Anne Jennifer Prabhu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Wound Infection ◽  
Artery Bypass ◽  
Correct Diagnosis ◽  
Relevant Literature ◽  
Specific Treatment ◽  
Wound Infections ◽  
Sternal Wound Infection ◽  
Review Of Literature ◽  
Sternal Wound Infections

Bacterial sternal wound infections following cardiac surgery are not uncommon. However, sternal wound infection by a fungus is a rarity, and it warrants a correct diagnosis followed by specific treatment. We report a case of Aspergillus sternal wound infection with costochondritis following cardiac surgery, and briefly review the relevant literature.

Safety of a 2-Day Antibiotic Regimen After Delayed Chest Closure Post Pediatric Cardiac Surgery

2018 ◽  
Vol 35 (8) ◽  
pp. 805-809 ◽  
Author(s):  
Joseph Philip ◽  
Christian Kegg ◽  
Dalia Lopez-Colon ◽  
Brian J. Kelly ◽  
Robert M. Lawrence ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Stream ◽  
Prophylactic Antibiotics ◽  
Pediatric Cardiac Surgery ◽  
Study Group ◽  
Wound Infections ◽  
Cardiac Intensive Care Unit ◽  
End Points ◽  
Cardiac Intensive Care ◽  
Sternal Wound Infections

Background: There is no consensus for the length of prophylactic antibiotics after delayed chest closure (DCC) postcardiac surgery in pediatrics. In September 2014, our institution’s pediatric cardiac intensive care unit changed the policy on length of prophylactic antibiotics after DCC from 5 days (control) to 2 days (study group). The objective of the study was to determine whether a 2-day course of antibiotics is as effective as a 5-day course in preventing blood stream and sternal wound infections in pediatric DCC. Methods: Retrospective and prospective study. Primary end points included incidence of sternal wound infections and positive sternal imaging for infection. Surrogate markers of infection were collected at 4 time points. Results: During the study period, 139 patients had DCC postcardiac surgery of which 110 patients were included for analysis, 54 patients in the control and 56 in the study group. There was no difference in total number of positive wound cultures/chest computed tomography (CT) findings (4/54 [7.5%] control vs 5/56 [8.9%] study group, P = .3), positive blood cultures ( P = .586), median postsurgical length of stay ( P = .4), or readmissions within 30 days postsurgery ( P = .6). All secondary end points were similar in both groups except peak heart rate between weeks 2 and 4 ( P = .041). Conclusion: Two days of prophylactic antibiotics is not inferior to 5 days of prophylactic antibiotics after DCC following pediatric cardiac surgery.

Deep Sternal Wound Infections After Cardiac Surgery: A New Australian Tertiary Centre Experience

2020 ◽  
Vol 29 (10) ◽  
pp. 1571-1578 ◽  
Author(s):  
Umar Ali ◽  
Liam Bibo ◽  
Madison Pierre ◽  
Nicholas Bayfield ◽  
Lior Raichel ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Wound Infections ◽  
Tertiary Centre ◽  
Sternal Wound Infections ◽  
Deep Sternal Wound Infections

scholarly journals Does a gentamicin-impregnated collagen sponge reduce sternal wound infections in high-risk cardiac surgery patients?

2012 ◽  
Vol 16 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Gabriel Birgand ◽  
Costin Radu ◽  
Soleiman Alkhoder ◽  
Nawwar Al Attar ◽  
Richard Raffoul ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Collagen Sponge ◽  
Wound Infections ◽  
Sternal Wound Infections

scholarly journals Sternal wound infections following cardiac surgery and their management: a single-centre study from the years 2016–2017

2018 ◽  
Vol 15 (2) ◽  
pp. 79-85 ◽  
Author(s):  
Agnieszka Kotnis-Gąska ◽  
Piotr Mazur ◽  
Aldona Olechowska-Jarząb ◽  
Andrzej Stanisz ◽  
Małgorzata Bulanda ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Wound Infections ◽  
Single Centre ◽  
Centre Study ◽  
Single Centre Study ◽  
Sternal Wound Infections

scholarly journals Effectiveness of a gentamicin impregnated collagen sponge on reducing sternal wound infections following cardiac surgery: a meta-analysis of randomised controlled trials

2012 ◽  
Vol 94 (4) ◽  
pp. 227-231 ◽  
Author(s):  
S Creanor ◽  
A Barton ◽  
A Marchbank
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Current Evidence ◽  
Controlled Trials ◽  
Wound Infections ◽  
Insufficient Evidence ◽  
Sternal Wound Infections ◽  
Randomised Controlled

INTRODUCTION Gentamicin impregnated collagen sponges are licensed for use after cardiac surgery in over 50 countries but their effectiveness at preventing sternal wound infections (SWIs) remains uncertain. The aim of this meta-analysis was to assess the current evidence for effectiveness of such sponges at preventing SWIs in patients after cardiac surgery. METHODS A systematic search of the literature was undertaken and meta-analyses were performed on the results of the identified, eligible studies. Using random effects models, odds ratios (OR) and corresponding 95% confidence intervals (Cl) were calculated for all SWIs and deep SWIs for: a) all participants, and b) participants deemed as high risk. RESULTS Three unique randomised controlled trials (published between 2005 and 2010) involving 3,994 participants met the inclusion criteria. There was insufficient evidence of a significant difference between intervention and control groups for all SWIs (all participants: OR: 0.66, 95% Cl: 0.39–1.14; high risk participants: OR: 0.60, 95% Cl: 0.24–1.52). There was insufficient evidence of a significant benefit of the sponge in deep SWIs across all participants (OR: 0.72, 95% Cl: 0.47–1.10) but some evidence of benefit in terms of reducing the incidence of deep SWIs in high risk participants (OR: 0.62, 95% Cl: 0.39–0.98). CONCLUSIONS There is insufficient evidence of the effectiveness (or otherwise) of gentamicin impregnated sponges in preventing SWIs following cardiac surgery. However, some evidence does exist that such sponges can reduce the incidence of deep infections in high risk patients.

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