masterThesis
Efecto del cambio de profilaxis antimicrobiana en cirugía cardiovascular con implante de prótesis en la Fundación Cardioinfantil
Fecha
2017Autor
Prieto Rayo, Yised Natalia
Pérez Fernández, José Leonardo
Institución
Resumen
INTRODUCTION: Mediastinitis is a deep infection of the surgical site with involvement of the retrosternal space, its incidence varies from 0. 2% to 5. 0% as reported by the American College of Cardiology / American Heart Association (ACC / AHA). OBJECTIVE: Establish the effect of the change of antibiotic prophylaxis scheme on the incidence of postoperative mediastinitis in patients undergoing cardiovascular surgery with prothesis implantation in the years 2012-2013 in the FCI-IC. METHODS: An observational, historical cohort study of patients undergoing cardiac surgery with prothesis implant. Cohorts of patients receiving Cephalosporins Vs Vancomycin-Gentamicin were compared. RESULTS: A population of 464 patients was analyzed, 163 received cephalosporin prophylaxis (Cef) and 301 Vancomycin - Gentamicin (Van - Gen) prophylaxis. The three most frequently performed procedures were aortic valve replacement (40. 1%), mitral valve (22. 2%) and Bentall`s surgery (11. 6%). The cumulative annual incidence of mediastinitis was 4. 76 and 1. 57 in 2012 and 2013 respectively, being higher in the group of Cef. The risk of occurrence of mediastinitis with Van-Gen was lower compared to the use of cephalosporins (RR 0. 25 IC 0. 08-0. 79) adjusted for age and gender. The main isolated germ was Staphylococcus Aureus MS (29. 4%). CONCLUSIONS: The incidence of mediastinitis in patients undergoing cardiac surgery with prothesis implantation, was lower in the group receiving antibiotic prophylaxis with Van-Gen compared to Cef.