澳大利亚冠状动脉搭桥手术并发手术部位感染：2010-2023年综合监测网络中感染率、手术抗菌预防和病原体的时间趋势

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-05-10 DOI:10.1016/j.jhin.2025.04.027

S.K. Tanamas , L.L. Lim , A.L. Bull , M.J. Malloy , J. Brett , Z. Dickson , L.J. Worth , N.D. Friedman

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引用次数: 0

摘要

背景：本研究报告了冠状动脉旁路移植术（CABG）手术部位感染（SSI）的流行病学趋势，并描述了外科抗菌预防（SAP）依从性和致病病原体随时间的变化。方法：对2010年至2023年提交给维多利亚州卫生保健相关感染监测协调中心的CABG手术数据进行分析。使用泊松回归对SSI率、选择、时间和持续时间的趋势进行建模。评估了导致SSI的最常见病原体及其随时间的变化。结果：在研究期间报告了32,446例CABG手术。胸骨SSI发生率从2010年的每100例手术2.7例下降到2023年的每100例手术1.6例，根据参与监测的年数调整模型后，每年下降15%。这种下降在前十年最为显著（IRR 0.70 [95% CI 0.64, 0.76]），随后在2020年至2023年期间保持稳定（IRR 1.08 [95% CI 0.93, 1.27]）。SAP选择的依从性一直在98%以上，而时间的依从性平均每年增加1%至83%，持续时间的依从性在75%至86%之间波动。导致SSI的最常见病原体是金黄色葡萄球菌、粘质沙雷菌、表皮葡萄球菌和肺炎克雷伯菌。涉及革兰氏阴性病原体的胸骨和供体部位ssi的比例从38%增加到59%。结论：这项对14年SSI合并CABG手术监测数据的分析强调了SSI发生率的降低，SAP抗菌药物选择的高依从性，以及金黄色葡萄球菌作为SSI的致病病原体在我们地区的优势。值得注意的是，我们观察到革兰氏阴性病原体，特别是粘质葡萄球菌，近年来造成了更大比例的ssi。

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Surgical site infections complicating coronary artery bypass graft surgery in Australia: time trends in infection rates, surgical antimicrobial prophylaxis, and pathogens using a comprehensive surveillance network, 2010–2023

Background

In cardiac surgery, surgical site infection (SSI) is associated with increased morbidity and mortality, reoperations, lengthy antimicrobial treatment, increased hospital length of stay, and increased healthcare costs.

Aim

To report trends in SSI epidemiology complicating coronary artery bypass graft (CABG) surgery and to record changes in surgical antimicrobial prophylaxis (SAP) compliance and causative pathogens over time.

Methods

Data on CABG procedures from 2010 to 2023 submitted to the Victorian healthcare-associated infection surveillance coordinating centre were analysed. Trends in the SSI rate and choice, timing, and duration of SAP were modelled using Poisson regression. The most common pathogens causing SSI and their change over time were assessed.

Findings

A total of 32,446 CABG procedures were reported during the study period. Sternal SSI rate decreased from 2.7 per 100 procedures in 2010 to 1.6 per 100 procedures in 2023, representing a 15% annual decrease, when the model was adjusted for the number of years of participation in surveillance. This decrease was most marked during the first decade (IRR 0.70 [95% CI 0.64, 0.76]) followed by stable rates between 2020 and 2023 (IRR 1.08 [95% CI 0.93, 1.27]). Compliance with SAP choice was consistently >98%, while compliance with timing increased by an average of 1% per year to 83%, and compliance with duration fluctuated between 75% and 86%. The most frequent pathogens responsible for SSI were Staphylococcus aureus, Serratia marcescens, Staphylococcus epidermidis, and Klebsiella pneumoniae. The proportion of sternal and donor site SSIs involving Gram-negative pathogens increased from 38% to 59%.

Conclusion

This analysis of 14 years of surveillance data for SSI complicating CABG procedures highlighted a reduction in rates of SSI, high rates of compliance with antimicrobial choice for SAP, and the predominance of S. aureus as a causative pathogen of SSI in our region. Notably, we observed Gram-negative pathogens, particularly S. marcescens, to be responsible for a larger proportion of SSIs over recent years.

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.