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Influence of a 5-year serial infection control and antibiotic stewardship intervention on cardiac surgical site infections

Published:April 25, 2016DOI:https://doi.org/10.1016/j.ajic.2016.02.029

      Highlights

      • An infection control and stewardship program decreases SSIs in cardiac surgery.
      • The impact of serial comprehensive interventions is maintained over time.
      • High single dose gentamicin added to infection control could further decrease SSIs.

      Background

      Surgical site infections (SSIs) complicate surgery, resulting in higher morbidity and mortality. Infection control bundles and antibiotic stewardship can be effective at reducing SSIs. The influence of long-term serial interventions is unclear.

      Objective

      The goal of this retrospective quasiexperimental study was to assess the influence of a 5-year serial infection control and antibiotic stewardship intervention on SSIs.

      Methods

      The multidisciplinary program actively implemented pre-, intra-, and postoperative strategies over a 5-year period from 2009-2014 for all patients undergoing coronary artery bypass graft (CABG), valve replacement, or both at a tertiary care public institution. Outcomes are compared with a 2-year preinterventions period (2007-2009) and 1-year postinterventions period (2014-2015).

      Results

      A total of 6,518 procedures were included. After interventions, the overall combined infection rate for CABG, CABG and valve, and valve procedures decreased by 66.3%, from 11.9%-4.0% (odds ratio, 0.34; 95% confidence interval, 0.23-0.49; P < .001). A significant decrease of >50% (P < .001) relative rate was observed in overall, sternum, leg, CABG, and combined CABG and valve infection rates when comparing pre- and postinterventions groups. The antibiotic stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 46.8%, from 39.8%-86.6% (95% confidence interval, 41.0-52.4; P < .001).

      Conclusion

      Long-term, serial comprehensive infection control and antibiotic stewardship interventions decrease overall SSIs in patients undergoing CABG and valve replacement procedures.

      Key Words

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      References

        • Kirkland K.B.
        • Briggs J.P.
        • Trivette S.L.
        • Wilkinson W.E.
        • Sexton D.J.
        The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs.
        Infect Control Hosp Epidemiol. 1999; 20: 725-730https://doi.org/10.1086/501572
        • de Lissovoy G.
        • Fraeman K.
        • Hutchins V.
        • Murphy D.
        • Song D.
        • Vaughn B.B.
        Surgical site infection: incidence and impact on hospital utilization and treatment costs.
        Am J Infect Control. 2009; 37: 387-397https://doi.org/10.1016/j.ajic.2008.12.010
        • Klevens R.M.
        • Edwards J.R.
        • Richards Jr, C.L.
        • Horan T.C.
        • Gaynes R.P.
        • Pollock D.A.
        • et al.
        Estimating health care-associated infections and deaths in U.S. hospitals, 2002.
        Public Health Rep. 2007; 122: 160-166
        • Braxton J.H.
        • Marrin C.A.
        • McGrath P.D.
        • Morton J.R.
        • Norotsky M.
        • Charlesworth D.C.
        • et al.
        10-year follow-up of patients with and without mediastinitis.
        Semin Thorac Cardiovasc Surg. 2004; 16: 70-76https://doi.org/10.1053/j.semtcvs.2004.01.006
        • Speir A.M.
        • Kasirajan V.
        • Barnett S.D.
        • Fonner Jr, E.
        Additive costs of postoperative complications for isolated coronary artery bypass grafting patients in Virginia.
        Ann Thorac Surg. 2009; 88 (discussion 45-46): 40-45https://doi.org/10.1016/j.athoracsur.2009.03.076
        • Lavu H.
        • Klinge M.J.
        • Nowcid L.J.
        • Cohn H.E.
        • Grenda D.R.
        • Sauter P.K.
        • et al.
        Perioperative surgical care bundle reduces pancreaticoduodenectomy wound infections.
        J Surg Res. 2012; 174: 215-221https://doi.org/10.1016/j.jss.2011.09.028
        • Kurz A.
        • Sessler D.I.
        • Lenhardt R.
        Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group.
        N Engl J Med. 1996; 334: 1209-1215https://doi.org/10.1056/NEJM199605093341901
        • Ambiru S.
        • Kato A.
        • Kimura F.
        • Shimizu H.
        • Yoshidome H.
        • Otsuka M.
        • et al.
        Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: a prospective study in a high-volume institute in Japan.
        J Hosp Infect. 2008; 68: 230-233https://doi.org/10.1016/j.jhin.2007.12.002
        • Bowater R.J.
        • Stirling S.A.
        • Lilford R.J.
        Is antibiotic prophylaxis in surgery a generally effective intervention? Testing a generic hypothesis over a set of meta-analyses.
        Ann Surg. 2009; 249: 551-556https://doi.org/10.1097/SLA.0b013e318199f202
        • Anderson D.J.
        • Kaye K.S.
        • Classen D.
        • Arias K.M.
        • Podgorny K.
        • Burstin H.
        • et al.
        Strategies to prevent surgical site infections in acute care hospitals.
        Infect Control Hosp Epidemiol. 2008; 29: S51-61https://doi.org/10.1086/676022
        • Center for Disease Control and Prevention
        Surgical site infection (SSI) event.
        (Available from:) (Updated April 2015; Accessed June, 2015)
        • Bratzler D.W.
        • Dellinger E.P.
        • Olsen K.M.
        • Perl T.M.
        • Auwaerter P.G.
        • Bolon M.K.
        • et al.
        Clinical practice guidelines for antimicrobial prophylaxis in surgery.
        Am J Health Syst Pharm. 2013; 70: 195-283https://doi.org/10.2146/ajhp120568
        • Edwards J.R.
        • Peterson K.D.
        • Mu Y.
        • Banerjee S.
        • Allen-Bridson K.
        • Morrell G.
        • et al.
        National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009.
        Am J Infect Control. 2009; 37: 783-805https://doi.org/10.1016/j.ajic.2009.10.001
        • Martorell C.
        • Engelman R.
        • Corl A.
        • Brown R.B.
        Surgical site infections in cardiac surgery: an 11-year perspective.
        Am J Infect Control. 2004; 32: 63-68https://doi.org/10.1016/j.ajic.2003.09.005
        • Finkelstein R.
        • Rabino G.
        • Mashiah T.
        • Bar-El Y.
        • Adler Z.
        • Kertzman V.
        • et al.
        Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program.
        Am J Infect Control. 2005; 33: 450-454https://doi.org/10.1016/j.ajic.2005.07.002
        • Graf K.
        • Sohr D.
        • Haverich A.
        • Kuhn C.
        • Gastmeier P.
        • Chaberny I.F.
        Decrease of deep sternal surgical site infection rates after cardiac surgery by a comprehensive infection control program.
        Interact Cardiovasc Thorac Surg. 2009; 9: 282-286https://doi.org/10.1510/icvts.2009.205286
        • Ju M.H.
        • Ko C.Y.
        • Hall B.L.
        • Bosk C.L.
        • Bilimoria K.Y.
        • Wick E.C.
        A comparison of 2 surgical site infection monitoring systems.
        JAMA Surg. 2015; 150: 51-57https://doi.org/10.1001/jamasurg.2014.2891
        • Riggi G.
        • Castillo M.
        • Fernandez M.
        • Wawrzyniak A.
        • Vigoda M.
        • Eber S.
        • et al.
        Improving compliance with timely intraoperative redosing of antimicrobials in surgical prophylaxis.
        Infect Control Hosp Epidemiol. 2014; 35: 1236-1240https://doi.org/10.1086/678058
        • White R.W.
        • West R.
        • Howard P.
        • Sandoe J.
        Antimicrobial regimen for cardiac surgery: the safety and effectiveness of short-course flucloxacillin (or teicoplanin) and gentamicin-based prophylaxis.
        J Card Surg. 2013; 28: 512-516https://doi.org/10.1111/jocs.12155
        • Schweizer M.L.
        • Chiang H.Y.
        • Septimus E.
        • Moody J.
        • Braun B.
        • Hafner J.
        • et al.
        Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery.
        JAMA. 2015; 313: 2162-2171https://doi.org/10.1001/jama.2015.5387
        • Schweizer M.
        • Perencevich E.
        • McDanel J.
        • Carson J.
        • Formanek M.
        • Hafner J.
        • et al.
        Effectiveness of a bundled intervention of decolonization and prophylaxis to decrease Gram positive surgical site infections after cardiac or orthopedic surgery: systematic review and meta-analysis.
        BMJ. 2013; 346: f2743https://doi.org/10.1136/bmj.f2743
        • Lee A.S.
        • Macedo-Vinas M.
        • Francois P.
        • Renzi G.
        • Schrenzel J.
        • Vernaz N.
        • et al.
        Impact of combined low-level mupirocin and genotypic chlorhexidine resistance on persistent methicillin-resistant Staphylococcus aureus carriage after decolonization therapy: a case-control study.
        Clin Infect Dis. 2011; 52: 1422-1430https://doi.org/10.1093/cid/cir233