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The rates of mortality and MRSA in cases of mediastinitis, the rate of MRSA mediastinitis after open heart surgery and the incidence of all nosocomial infections caused by MRSA during the study period.
Source publication
Objective:
The mortality rate of patients with poststernotomy mediastinitis remains very high. The aim of this study was to identify the risk factors associated with mortality in these patients.
Subjects and methods:
Surveillance of sternal surgical-site infections including mediastinitis was carried out for adult patients undergoing a sternotom...
Citations
... Serap et al., estudió 19 767 pacientes que fueron llevados a cirugía cardíaca, de los cuales 117 (0,39%) presentaron mediastinitis post-esternotomía, 32% de estos 117 pacientes fallecieron. Grauhan et al., estudió 150 pacientes obesos que fueron llevados a esternotomía mediana encontrando un riesgo de 6,1% para desarrollar mediastinitis post-esternotomía 13,14 . ...
Mediastinitis is a rare and devastating complication of cardiac surgery, it increases the cost of care. Patients with mediastinitis after cardiac surgery have higher morbidity and mortality. Obesity is the only modifiable perioperative risk factor for mediastinitis. The aim of this case report is to describe the management of mediastinitis after cardiac surgery that includes vacuum assisted pressure with a subsequent fixation of the thorax wall with titanium bars. MÉD.UIS. 2017;30(1):107-111.
... Yavuz et al. [1] investigated independent risk factors in patients suffering from PSM. The study clearly showed that improvement of infection control interventions can dramatically decrease SSI rates. ...
... Even if the mortality is very high, the only adequate antibiotic therapy seems insufficient, as survival data showed. This study also supports the finding that delayed appropriate antibiotic therapy will result in a statistically significant increase in mortality [1] . ...
Deep sternal wound infection (DSWI) is a rare but potentially devastating complication of median sternotomy performed in cardiac surgery. The incidence of DSWI is reported to be between 0.2% and 3%. Identifying high-risk patients and strategies to optimize risk factors plays an important role in reducing the incidence of DSWI. Management of DSWI can be complex and may require a multidisciplinary team approach involving infectious disease specialists, microbiologists, as well as cardiothoracic and plastic surgeons. Early detection, appropriate antibiotic treatment, aggressive surgical debridement, and use of regional muscle flaps have significantly improved treatment outcomes.
Sternale Wundinfektionen nach kardiochirurgischen Eingriffen sind mit einer hohen Morbidität und Mortalität verbunden. Deshalb ist es wichtig, beeinflussbare Risikofaktoren für Wundinfektionen zu identifizieren und nach Möglichkeit zu minimieren. Der präoperativen Besiedlung mit S. aureus wird in diesem Zusammenhang eine große Bedeutung beigemessen.
Im Rahmen der hier vorliegenden Untersuchung am UHZ, Standort Bad Krozingen, erhalten 101 kardiochirurgische Patienten mit Sternotomie im Oktober und November 2013 eine perioperative Anwendung des Haut- und Schleimhautantiseptikums Octenidin in Form einer Waschlotion und eines Nasen-Gels, unabhängig eines eventuellen Trägerstatus mit S. aureus. Begleitend werden Abstriche aus Nase und Rachen gewonnen, um Erkenntnisse darüber zu gewinnen, wie hoch der Anteil an S. aureus-Trägern ist und wie sich die perioperativen Maßnahmen auf die S. aureus-Besiedlung auswirken.
Mit Hilfe der Octenidin-Anwendungen kann perioperativ eine Reduktion der Besiedlung mit S. aureus um 72% erzielt werden. Eine Wundinfektion tritt bei den eingeschlossenen 101 Patienten nicht auf.
Für die Studienpatienten werden Risikofaktoren für sternale postoperative Wundinfektionen erfasst und in die Literatur eingebettet.
Die vorliegende Untersuchung liefert Hinweise darauf, dass die Anwendung des Antiseptikums Octenidin ausreichen könnte, eine perioperative Staphylokokkensuppression zu erzielen. Dadurch wird es möglich, den Risikofaktor der Besiedlung mit S. aureus perioperativ kostengünstig und ohne großen Aufwand und dem Risiko einer Resistenzentwicklung zu reduzieren, was sich wiederum positiv auf das Auftreten von postoperativen Wundinfektionen auswirken könnte.
Es sind weitere Untersuchungen mit einer größeren Anzahl an Patienten sowie über einen längeren Zeitraum notwendig, um sichere Aussagen bezüglich der Suppression der Staphylokokken-Besiedlung und der Auswirkung auf postoperative sternale Wundinfektionen treffen zu können.
Background
Accurate estimates of the burden of antimicrobial resistance (AMR) are needed to establish the magnitude of this global threat in terms of both health and cost, and to paramaterise cost-effectiveness evaluations of interventions aiming to tackle the problem. This review aimed to establish the alternative methodologies used in estimating AMR burden in order to appraise the current evidence base.
Methods
MEDLINE, EMBASE, Scopus, EconLit, PubMed and grey literature were searched. English language studies evaluating the impact of AMR (from any microbe) on patient, payer/provider and economic burden published between January 2013 and December 2015 were included. Independent screening of title/abstracts followed by full texts was performed using pre-specified criteria. A study quality score (from zero to one) was derived using Newcastle-Ottawa and Philips checklists. Extracted study data were used to compare study method and resulting burden estimate, according to perspective. Monetary costs were converted into 2013 USD.
Results
Out of 5187 unique retrievals, 214 studies were included. One hundred eighty-seven studies estimated patient health, 75 studies estimated payer/provider and 11 studies estimated economic burden. 64% of included studies were single centre. The majority of studies estimating patient or provider/payer burden used regression techniques. 48% of studies estimating mortality burden found a significant impact from resistance, excess healthcare system costs ranged from non-significance to $1 billion per year, whilst economic burden ranged from $21,832 per case to over $3 trillion in GDP loss. Median quality scores (interquartile range) for patient, payer/provider and economic burden studies were 0.67 (0.56-0.67), 0.56 (0.46-0.67) and 0.53 (0.44-0.60) respectively.
Conclusions
This study highlights what methodological assumptions and biases can occur dependent on chosen outcome and perspective. Currently, there is considerable variability in burden estimates, which can lead in-turn to inaccurate intervention evaluations and poor policy/investment decisions. Future research should utilise the recommendations presented in this review.
Trial registration
This systematic review is registered with PROSPERO (PROSPERO CRD42016037510).
Electronic supplementary material
The online version of this article (10.1186/s13756-018-0336-y) contains supplementary material, which is available to authorized users.
