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Master Thesis

Incidence, microbiologie, facteurs de risque et pronostic des infections du site opératoire (ISO) profondes après chirurgie cardiaque : une analyse rétrospective de la cohorte de chirurgie cardiaque « PESSAC »

Abstract : Background: deep surgical site infection (SSI) is a major complication after cardiac surgery. We conducted a large-scale retrospective study to determine incidence, microbiologic profile, risk factors and the impact on mortality of deep SSI defined according to the new Centers for Disease Control and Prevention (CDC) definition. Methods: we reviewed retrospectively perioperative characteristics of patients underwent on-pump cardiac surgery from September 2010 to May 2014. Deep SSI was defined as the need of sternal reopening for purulence discharge, sternal destruction or dehiscence. Multiple logistic regression analysis and propensity score adjustment were used. Results: a total of 4835 patients were analyzed. Among them, 68 (1.4%) patients developed a deep SSI. The most common bacteria involved in deep SSI was the Staphylococcus aureus (25%). Median onset time for diagnosis was 17 [10-31] days. The independent risk factors associated to deep SSI were re-exploration for bleeding (OR: 3.79; 95%CI, 1.62-8.87), coronary artery bypass grafting surgery (CABG) (OR: 1.68; 95%CI, 1.39-1.83), prior myocardial infarction (OR: 2.93; 95%CI, 1.21-7.09), perioperative transfusion (OR: 2.04; 95%CI, 1.01-4.09), maximal postoperative blood glucose (OR: 1.13; 95%CI, 1.08-1.18), preoperative serum creatinin (OR: 1.03; 95%CI, 1.01-1.06) and BMI (OR: 1.11; 95%CI, 1.06-1.16). After adjustment of perioperative factors by propensity score, the occurrence of deep SSI was not significantly associated with mortality in ICU (OR: 1.80; 95%CI, 0.61-5.29, p=0.29). Conclusions: in a high annual center-level volume of cardiac surgical procedures, the incidence of deep SSI according to CDC definitions remains relatively low. Some modifiable risk factors should be considered by attending care physician and actively corrected.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01766803
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Saturday, April 14, 2018 - 10:34:55 AM
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Julien Imbault. Incidence, microbiologie, facteurs de risque et pronostic des infections du site opératoire (ISO) profondes après chirurgie cardiaque : une analyse rétrospective de la cohorte de chirurgie cardiaque « PESSAC ». Médecine humaine et pathologie. 2018. ⟨dumas-01766803⟩

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