The relationship between diabetes and surgical site infection following coronary artery bypass graft surgery in current-era models of care. (October 2021)

• Record Type: Journal Article
• Authors: Cheuk, N.; Worth, L.J.; Tatoulis, J.; Skillington, P.; Kyi, M.; Fourlanos, S.
• Is Part Of: Journal of hospital infection. Volume 116(2021)
• Page Start: 47
• Page End: 52
• Publication Date: 2021-10
• Subjects: Diabetes -- Infection -- Coronary -- Bypass -- Graft -- Surgery; BGL Blood glucose level -- CABGS Coronary artery bypass graft surgery -- CIII Continuous intravenous insulin infusion -- T2D Type 2 diabetes -- VICNISS Victorian Healthcare Associated Infection Surveillance System; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2021.07.009
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: Although diabetes is a recognized risk factor for postoperative infections, the seminal Portland Diabetic Project studies in cardiac surgery demonstrated intravenous insulin infusions following open-cardiac surgery achieved near normal glycaemia and decreased deep sternal wound infection to similar rates to those without diabetes. Aim: We sought to examine a contemporary cohort of patients undergoing coronary artery bypass graft surgery (CABGS) to evaluate the relationship between diabetes, hyperglycaemia and risk of surgical site infection (SSI) in current-era models of care. Methods: Consecutive patients who underwent CABGS between 2016 and 2018 were identified through a state-wide data repository for healthcare-associated infections. Clinical characteristics and records of postoperative SSIs were obtained from individual chart review. Type 2 diabetes (T2D), perioperative glycaemia and other clinical characteristics were analysed in relation to the development of SSI. Findings: Of the 953 patients evaluated, 11% developed SSIs a median eight days post CABGS, with few cases of deep SSIs (<1%). T2D was evident in 41% and more prevalent in those who developed SSIs (51%). On multivariate analysis T2D was not significantly associated with development of SSI (odds ratio (OR) 1.35; P =0.174) but body mass index (BMI) remained a significant risk factor (OR 1.07, P <0.001). In patients with T2D, perioperative glycaemia was not significantly associated with SSI. Conclusion: In a specialist cardiac surgery centre using perioperative intravenous insulin infusions and antibiotic prophylaxis, deep SSIs were uncommon; however, approximately one in 10 patients developed superficial SSIs. T2D was not independently associated with SSI yet BMI was independently associated with SSI post CABGS.