THE EPIDEMIOLOGY OF CHEST AND LEG WOUND INFECTIONS FOLLOWING CARDIOTHORACIC SURGERY

The occurrence of wound infections following cardiothoracic surgery ha s significant implications. However, the epidemiology of all chest and leg wound infections is infrequently described, and the effects on mo rbidity, mortality, and cost of care remain undefined. We identified 1 82 superficial and deep chest and leg infections in 163 patients follo wing 1,554 coronary artery bypass graft (CABG), valve, and CABG/valve procedures over 30 months. The overall infection rate was 11.7%; infec tions of specific sites involved in the 1,554 procedures occurred at t he following rates: 3.1%, superficial chest wounds; 2.3%, deep chest w ounds; 4.6%, superficial. leg wounds; and 2.2%, deep leg wounds. Chest infection rates were similar for all procedures. Multiple infections occurred in 9.8% of patients and were associated with female sex, diab etes, and prolonged surgery (P <.05). Purulent drainage and fever were more common in chest infections; erythema and pain were more common i n leg infections (P <.05). Staphylococcus aureus (32.9%), coagulase-ne gative staphylococci (27.4%), and Enterobacteriaceae (26.0%) were iden tified most commonly. Enterobacteriaceae were more commonly isolated f rom leg wounds (P <.05). Adverse outcomes included reexploration (20.9 %), flap surgery (12.3%), and death (4.3%). All adverse outcomes were more commonly associated with deep chest infections (P <.05), but supe rficial chest and leg infections also had a substantial impact on card iothoracic surgery-related morbidity. Studies are needed to define sit e-specific risk factors so that the full potential of prevention and c ontrol measures can be realized.