Fungal and bacterial co-infection in the superficial and deep sternal wound after open cardiac surgery
Abstract
Background and Objectives: Sternum infection increases the time of the patients stay in the hospital and, as a result, increases the treatment costs. This study aimed to evaluate the fungal and bacterial co-infection in the superficial and deep sternal wounds after open cardiac surgery and its relationship with risk factors, as sternal infection increases the time of the patient's stay in the hospital and, as a result, increases the treatment costs.
Materials and Methods: Data were collected using a questionnaire and sampling with two swabs after open heart surgery and hospitalization from 21 March 2018 to 20 March 2019 and sent to the laboratory for diagnosis of microorganisms effective in wound infection. Susceptibility testing for fluconazole and specific antibiotics was performed by the disk diffusion method.
Results: Out of 210 patients studied, 2% of patients had deep sternal wound infections. The most common coinfection fungal and bacterial agents in sternal wounds were caused by Staphylococcus aureus with Candida glabrata 4% and Escherichia coli with Candida albicans 2%. S. aureus and E. coli showed the highest antibiotic susceptibility to the antibiotics ciprofloxacin, norfloxacin, meropenem, and imipenem. Candida glabrata and Candida albicans had the highest rate of resistance to fluconazole.
Conclusion: According to the results of this study, patients on the 7th day in the cardiac care unit (CCU) and the 28th day are at higher risk of getting confection of fungi with bacteria in the sternal wound. Therefore, timely and appropriate antibiotic therapy, including the use of appropriate antibiotics, can be an important step in the patient's recovery.
2. Filsoufi F, Castillo JG, Rahmanian PB, Broumand SR, Silvay G, Carpentier A, et al. Epidemiology of deep sternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth 2009; 23: 488-494.
3. Floros P, Sawhney R, Vrtik M, Hinton-Bayre A, Weimers P, Senewiratne S, et al. Risk factors and management approach for deep sternal wound infection after cardiac surgery at a tertiary medical centre. Heart Lung Circ 2011; 20: 712-717.
4. Storey A, MacDonald B, Rahman MA. The association between preoperative length of hospital stay and deep sternal wound infection: A scoping review. Aust Crit Care 2021; 34: 620-633.
5. Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg 2016; 152: 962-972.
6. Kotnis-Gąska A, Mazur P, Olechowska-Jarząb A, Stanisz A, Bulanda M, Undas A. Sternal wound infections following cardiac surgery and their management: a single-centre study from the years 2016-2017. Kardiochir Torakochirurgia Pol 2018; 15: 79-85.
7. Chen LF, Arduino JM, Sheng S, Muhlbaier LH, Kanafani ZA, Harris AD, et al. Epidemiology and outcome of major postoperative infections following cardiac surgery: risk factors and impact of pathogen type. Am J Infect Control 2012; 40: 963-968.
8. Lepelletier D, Bourigault C, Roussel JC, Lasserre C, Leclère B, Corvec S, et al. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect 2013; 43: 403-409.
9. Mekontso Dessap A, Vivier E, Girou E, Brun-Buisson C, Kirsch M. Effect of time to onset on clinical features and prognosis of post-sternotomy mediastinitis. Clin Microbiol Infect 2011; 17: 292-299.
10. Singh K, Anderson E, Harper JG. Overview and management of sternal wound infection. Semin Plast Surg 2011; 25: 25-33.
11. Yusuf E, Chan M, Renz N, Trampuz A. Current perspectives on diagnosis and management of sternal wound infections. Infect Drug Resist 2018; 11: 961-968.
12. Hosseinrezaei H, Rafiei H, Amiri M. Incidence and risk factors of sternal wound infection at site of incision after open-heart surgery. J Wound Care 2012; 21: 408-411.
13. Legesse Laloto T, Hiko Gemeda D, Abdella SH. Incidence and predictors of surgical site infection in Ethiopia: prospective cohort. BMC Infect Dis 2017; 17: 119.
14. Bertesteanu S, Triaridis S, Stankovic M, Lazar V, Chifiriuc MC, Vlad M, et al. Polymicrobial wound infections: pathophysiology and current therapeutic approaches. Int J Pharm 2014; 463: 119-126.
15. Cove ME, Spelman DW, MacLaren G. Infectious complications of cardiac surgery: a clinical review. J Cardiothorac Vasc Anesth 2012; 26: 1094-1100.
16. Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. J Clin Microbiol 2021; 59(12): e0021321.
17. Howlader MH, Smith JE, Madden BP. An approach to improve early detection of sternal wound infection. Bangladesh Med Res Counc Bull 2009; 35: 11-14.
18. Mirhendi H, Makimura K, Khoramizadeh M, Yamaguchi H. A one-enzyme PCR-RFLP assay for identification of six medically important Candida species. Nihon Ishinkin Gakkai Zasshi 2006; 47: 225-229.
19. Bouza E, de Alarcón A, Fariñas MC, Gálvez J, Goenaga MÁ, Gutiérrez-Díez F, et al. Prevention, diagnosis and management of post-surgical mediastinitis in adults consensus guidelines of the Spanish society of cardiovascular infections (SEICAV), the Spanish society of thoracic and cardiovascular surgery (SECTCV) and the biomedical research centre network for respiratory diseases (CIBERES). J Clin Med 2021; 10: 5566.
20. Bartoletti M, Mikus E, Pascale R, Giannella M, Tedeschi S, Calvi S, et al. Clinical experience with dalbavancin for the treatment of deep sternal wound infection. J Glob Antimicrob Resist 2019; 18: 195-198.
21. Ma J-G, An J-X. Deep sternal wound infection after cardiac surgery: a comparison of three different wound infection types and an analysis of antibiotic resistance. J Thorac Dis 2018; 10: 377-387.
22. Spindler N, Biereigel C, Pieroh P, Schroeter T, Misfeld M, Josten C, et al. Clinical and microbiological analysis of deep sternal wound infections in fifty-two consecutive patients. Surg Infect (Larchmt) 2020; 21: 370-377.23. Parissis H,
Al-Alao B, Soo A, Orr D, Young V. Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition. J Cardiothorac Surg 2011; 6: 111.
24. Shi Y-D, Qi F-Z, Zhang Y. Treatment of sternal wound infections after open-heart surgery. Asian J Surg 2014; 37: 24-29.
25. Gårdlund B, Bitkover CY, Vaage J. Postoperative mediastinitis in cardiac surgery - microbiology and pathogenesis. Eur J Cardiothorac Surg 2002; 21: 825-830.
26. Hariri G, Genoud M, Bruckert V, Chosidow S, Guérot E, Kimmoun A, et al. Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome. Crit Care 2023; 27: 6.
27. Chaudhuri A, Shekar K, Coulter C. Post-operative deep sternal wound infections: making an early microbiological diagnosis. Eur J Cardiothorac Surg 2012; 41: 1304-1308.
28. Guan H, Dong W, Lu Y, Jiang M, Zhang D, Aobuliaximu Y, et al. Distribution and Antibiotic Resistance Patterns of Pathogenic Bacteria in Patients With Chronic Cutaneous Wounds in China. Front Med (Lausanne) 2021; 8: 609584.
29. Gadepalli R, Dhawan B, Sreenivas V, Kapil A, Ammini AC, Chaudhry R. A clinico-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital. Diabetes Care 2006; 29: 1727-1732.
30. Heydarpour F, Rahmani Y, Heydarpour B, Asadmobini A. Nosocomial infections and antibiotic resistance pattern in open-heart surgery patients at Imam Ali Hospital in Kermanshah, Iran. GMS Hyg Infect Control 2017; 12: Doc07.
| Files | ||
| Issue | Vol 15 No 3 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v15i3.12899 | |
| Keywords | ||
| Co-infection; Fungi; Bacteria; Risk factors | ||
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