The epidemiology and consequences of wound infections caused by coagulase negative staphylococci after thoracic surgery
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Nosocomial infections in general and postoperative infections in pmticular are important aspects of modern health care. They are important factors to be taken into account when planning and organizing any kind of surgery. Thoracic surgery has become a common and important form of surgery involving significant amounts of patients and resources. Different kinds of infectious complications are not uncommon and cause considerable problems. Many microbes have been implicated in post-operative infections, but one of the most important ones in activities such as thoracic surgety is Coagulase Negative Staphylococci (CoNS). They exist in our environment and produce infections that are difficult to diagnose and complicated to treat. The source of the infections and the transmission routes remain to a great extent unclear.
To describe the basic epidemiology of sterna! infections after cardiac surgery and to find early indications of infections.To investigate the epidemiology of Coagulase Negative Staphylococci causing sternal infections and to describe the development of antibiotic resistance.
Methods and results
To describe and evaluate the impact of infections after thoracic surgety in our hospital we followed different patient populations. When examining the patients being infected we could show that risk factors mostly involved surgery and hospital related variables. The diagnosis of the infections was often late and the treatment is difficult and consuming major resomces. The late diagnosis could be explained by the discrete symptoms and that a marker for infection like CRP are difficult to evaluate in the post-operative patient. With increased surveillance of the wounds an earlier diagnosis would be possible. Following the development of the management of the infections in our hospital during the 90's we could also show that the time to diagnosis and the treatment periods became shorter.
CoNS caused the majority of the infections in our patients with little change during the 10-year petiod. Preliminary results indicate that the source of the CoNS is the hospital environment in a majority of the serious infections. The place and route of transmission is unclear but the operating theatre remains a possible place of transmissions. Even if the resistance patterns of the CoNS are quite diverse they are often multi resistant and to a substantial degree vancomycin remains the only antibiotic that can be used for the treatment.
Wound infections after cardiac surgery are an important cause of morbidity and mortality, and CoNS play a major role in these infections. Risk factors that contribute to the infections are often associated with complicated surgery. Symptoms of the infections are often discrete and the diagnosis and treatment of the infections often stmt late. Intensified surveillance of the wounds could improve management of infections. We found a clone of CoNS causing a majority of the infections indicating that the source of the bacteria is often the hospital environment. CoNS as a major pathogen makes antibiotic treatment difficult, and there is a high risk of extensive antibiotic resistance.
Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 35 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 742
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-26672Local ID: 11239ISBN: 91-7373-186-2OAI: oai:DiVA.org:liu-26672DiVA: diva2:247221
2002-09-27, Elsa Brändsströmsalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Wiström, Johan, Docent
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