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(HealthNewsDigest.com) – ORLANDO, Fla., Nov. 15, 2011 — Pneumonia — not a deep incision surgical site infection — is the most common serious infection after heart surgery, according to new research (Abstract 12247) presented at the American Heart Association’s Scientific Sessions 2011.
The study also revealed that most infections occur about two weeks
after surgery, not one week as physicians previously thought.
“It’s not what we expected to find,” said Michael A. Acker, M.D., the
study’s lead researcher and professor and chief of cardiovascular
surgery at the University of Pennsylvania Medical Center in
Philadelphia, Pa.
In abstract 12247, researchers analyzed more than 5,100 patients in a
heart surgery registry. Patients, average age 64, were treated at nine
U.S. academic medical centers and one Canadian center. The median time
to major infection was 14 days after heart surgeries. Forty-three
percent of all major infections occurred after hospital discharge.
“Half of these patients had no evidence of infection before they were
discharged from the hospital,” Acker said. “Then they had to return
because of the new infection. One implication is that patients must be
followed more closely after discharge.”
In this study, which excluded patients who were infected before
surgery, researchers found 761 infections: 300 were classified as major
infections (occurring in 6 percent of patients) and 461 were minor (in
8.1 percent of patients). Of the major infections:
— Pneumonia, infection of the lungs, occurred in 2.4 percent of all
patients.
— C. difficile colitis, an intestinal infection, occurred in 1.0 percent.
— Bloodstream infections occurred in 1.1 percent.
— Deep-incision surgical site infections occurred in 0.5 percent.
Minor infections included urinary tract and superficial incision site
infections.
The most commonly performed procedures were isolated coronary artery
bypass graft and aortic and mitral valve surgeries. Seventy-four
percent were elective surgeries and 26 percent were non-elective or
emergency surgeries.
Several risk factors appeared to increase the risk of developing
infection, including congestive heart failure, hypertension, chronic
lung disease, corticosteroid use prior to surgery, and length of
cardiopulmonary bypass time.
“In the next level of analysis, the focus will be on differences in
care, from the types of dressings, the types of antibiotics, and the
types of surgical preparations, to show what processes of care are
associated with decreased incidence of infections,” Acker said. “The
registry will allow us to modify our best practices to manage
post-operative infections.”
Co-authors are Michael Argenziano, M.D.; John D. Puskas, M.D., M.Sc.;
T. Bruce Ferguson, M.D.; Annetine C. Gelijns, Ph.D.; Keith Horvath,
M.D.; Marissa A. Miller, DVM, MPH; Stacey Welsh, R.N.; Ellen Moquete,
R.N.; Kevin N. Su, B.S. Alan Weinberg, M.S.; Alan J. Moskowitz, M.D.;
Patrick T. O’Gara, M.D. and Eugene H. Blackstone, M.D.
The National Heart, Lung, and Blood Institute, National Institute of
Neurological Disorders and Stroke and Canadian Institutes of Health
Research funded the study.
Skin preparation reduces cardiac implantable device infections
In another study (abstract 10041), special skin preparations for 3,700
patients significantly reduced infections from cardiac implantable
electronic devices.
Researchers at a Milwaukee hospital washed patients’ skin with a
special antibacterial solution the night before and morning of the
procedure. They also included a strict three-minute drying time for the
surgical skin preparation. These steps decreased implant infection
rates from 1 percent to 0.24 percent at a year following the implant
placement.
More staphylococcal bacterial infections are occurring after
implantation procedures, said Renee Koeberl, R.N., M.S.N., lead author
of the study.
Co-authors are Mohamed S. Rahman, M.D.; Rachel Pedersen, B.A.; Jasbir
Sra, M.D.; Masood Akhtar, M.D. and M. Eyman Mortada, M.D. Author
disclosures are on the abstract.
Statements and conclusions of study authors published in American Heart
Association scientific journals are solely those of the study authors
and do not necessarily reflect the association’s policy or position.
The association makes no representation or guarantee as to their
accuracy or reliability. The association receives funding primarily
from individuals; foundations and corporations (including
pharmaceutical, device manufacturers and other companies) also make
donations and fund specific association programs and events. The
association has strict policies to prevent these relationships from
influencing the science content. Revenues from pharmaceutical and
device corporations are available at www.heart.org/corporatefunding.
NR11-1144 (SS11/author)
Notes: Actual presentation of abstract 10041 is 3 p.m. ET, Tuesday,
Nov. 15.
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