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Enterobacter Mediastinitis Following Cardiac Surgery

Published online by Cambridge University Press:  02 January 2015

Darwin L. Palmer ,
Joel N. Kuritsky ,
Sandra C. Lapham ,
Rosalie M. King  and
Bechara F. Akl
Darwin L. Palmer*
Affiliation:
Veterans Administration Medical Center, the Department of Medicine, and the Department of Surgery, The University of New Mexico School of Medicine, Albuquerque, New Mexico, and the Epidemiology Program Office, Centers for Disease Control, United States Public Health Service, Atlanta, Georgia
Joel N. Kuritsky
Affiliation:
Veterans Administration Medical Center, the Department of Medicine, and the Department of Surgery, The University of New Mexico School of Medicine, Albuquerque, New Mexico, and the Epidemiology Program Office, Centers for Disease Control, United States Public Health Service, Atlanta, Georgia
Sandra C. Lapham
Affiliation:
Veterans Administration Medical Center, the Department of Medicine, and the Department of Surgery, The University of New Mexico School of Medicine, Albuquerque, New Mexico, and the Epidemiology Program Office, Centers for Disease Control, United States Public Health Service, Atlanta, Georgia
Rosalie M. King
Affiliation:
Veterans Administration Medical Center, the Department of Medicine, and the Department of Surgery, The University of New Mexico School of Medicine, Albuquerque, New Mexico, and the Epidemiology Program Office, Centers for Disease Control, United States Public Health Service, Atlanta, Georgia
Bechara F. Akl
Affiliation:
Veterans Administration Medical Center, the Department of Medicine, and the Department of Surgery, The University of New Mexico School of Medicine, Albuquerque, New Mexico, and the Epidemiology Program Office, Centers for Disease Control, United States Public Health Service, Atlanta, Georgia
*
Veterans Administration Medical Center, 2100 Ridgecrest Drive, S.E., Albuquerque, NM 87108
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Abstract

Eight cases of sternal/mediastinal infection due to Enterobacter species were seen in postoperative cardiac patients during 1980 to 1981. The attack rate was 14.5% (8/55), compared to 3.7% (2/54) for an identical period in 1979 to 1980 (p<0.05). Cases varied in severity from fulminant, acute bacteremic infections (one death) to less severe wound infection. Late complications or recurrences were not seen. There was a hospital-wide increase, relative to all other gram-negative bacillary isolates, in Enterobacter laboratory isolations, but no increased rate of infection in any other specific surgical condition.

No personnel, materials, or techniques were associated with the outbreak, and all but two environmental cultures were negative. Case-control analysis suggested that surgical complications and prophylactic cephalosporins were associated with infection. Prospectively, an additional 85 cardiac surgery patients had increased Enterobacter skin/wound colonization following perioperative prophylaxis with cephalosporin antibiotics. After introduction of barrier isolation and restriction of contacts no further mediastinitis occurred in 100 subsequent cardiac surgery patients. This study indicates that Enterobacter may be major pathogens causing post-cardiac-surgery infection not prevented by cephalosporin prophylaxis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 6 , Issue 3 , March 1985 , pp. 115 - 119
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1985

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References

1. Culliford, AT, Cunningham, JN Jr, Zeff, RH, et al: Sternal and costochondral infections following open-heart surgery. A review of 2,594 cases. J Thorac Cardiovasc Surg 1976; 72:714–726.Google Scholar
2. Baffes, TG, Blazek, WV, Fridman, JL, et al: Postoperative infection in 1,136 consecutive cardiac operations. Surgery 1970; 68:791–799.Google Scholar
3. Bor, DH, Rose, RM, Modlin, JF, et al: Mediastinitis after cardiovascular surgery. Rev Infect Dis 1983; 5:885–897.CrossRefGoogle ScholarPubMed
4. Engelman, RM, William, CD, Gouge, TH, et al: Mediastinitis following open-heart surgery. Review of two years experience. Arch Surg 1973; 107:772–778.Google Scholar
5. Jimenez-Martinez, M, Arguero-Sanchez, R, Perez-Alvarez, JJ, et al: Anterior mediastinitis as a complication of median sternotomy incision. Diagnostic and therapeutic considerations. Surgery 1970; 67:929–934.Google Scholar
6. Rosendorf, LL, Diacoff, G, Baer, H: Sources of gram-negative infection after open-heart surgery. J Thorac Cardiovasc Surg 1974; 67:195–201.CrossRefGoogle ScholarPubMed
7. Attah, CA, Cerruti, MM: Aspergillus osteomyelitis of the sternum after surgery. NY State J Med 1979; 79:1420–1421.Google Scholar
8. Williams, CD, Cunningham, JN, Falk, EA, et al: Chronic infection of the costal cartilages after thoracic surgical procedures. J Thorac Cardiovasc Surg 1973; 66:595–598.Google Scholar
9. Robicsek, F, Daugherty, HK, Cook, JW, et al: Mycobacterium fortuitum epidemics after open-heart surgery. J Thorac Cardiovasc Surg 1978; 75:91–96.CrossRefGoogle ScholarPubMed
10. Weinstein, RA, Jones, EL, Schwarzmann, SW, et al: Sternal osteomyelitis and mediastinitis after open heart operation: Pathogenesis and prevention. Ann Thorac Surg 1976; 21:422–444.Google Scholar
11. Marples, MJ: The gram-negative bacilli, in Marples, MJ (ed): The Ecology of the Human Skin. Springfield, 1965, pp 690–712.Google Scholar
12. Centers for Disease Control: Bacteremia among aortic-valve surgery patients—Boston. MMWR 1982; 31:88–89.Google Scholar
13. Martin, WJ, Washington, JA II: Enterobacterioceae, in Lenette, EH, Bellows, A, Hansler, WJ (eds): Manual of Clinical Microbiology, ed 3. Washington, DC, American Society of Microbiology, 1980, pp 195–219.Google Scholar