Authors
Shevchenko Yu.L., Susov R.P.
St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
Abstract
The amount of the most common pyoinflammatory complications (surgical site infections, pleural empyema, nosocomial pneumonia, urinary tract infections, angiogenic sepsis) in cardiothoracic surgery has decreased significantly in recent decades but remains quite high. The applied therapeutic and diagnostic algorithms do not always allow their early detection, and the current methods of prevention are scattered and not applied comprehensively, which makes them imperfect and cannot be considered a satisfactory result. Finding ways to reduce the incidence of postoperative complications is a priority.
The review considers the incidence and factors of postoperative infectious and inflammatory complications, the methods of prevention and treatment used. The strategy aimed to reduce the rate of purulent surgical complications and improve the results of surgical intervention is formulated.
Keywords: pyoinflammatory complications, surgical infection, pleural empyema, nosocomial pneumonia, urinary tract infection, angiogenic sepsis.
References
1. Aasen DM, Bronsert MR, Rozeboom PD, et al. Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database. Surgery. 2021; 169(2): 325-332. doi: 10.1016/j.surg.2020.08.009.
2. Bokerija LA, Beloborodova NV. Infekcija v kardiohirurgii. A.N. Bakoulev Scientific Center for Cardiovascular Surgery; 2007. 583 p. (In Russ).
3. Conte JV, Baumgartner WA, Dorman T, et al. The Johns Hopkins manual of cardiac surgical care. 2nd ed. Elsevier Science; 2007.
4. Rosenthal VD, Richtmann R, Singh S, et al. Surgical site infections, International Nosocomial Infection Control Consortium (INICC) report, data summary of 30 countries, 2005–2010. Infect Control Hosp Epidemiol. 2013; 34(6): 597-604. doi: 10.1086/670626.
5. Ibañez J, Riera M, Amezaga R, et al. Long-Term Mortality After Pneumonia in Cardiac Surgery Patients: A Propensity-Matched Analysis. J Intensive Care Med. 2016; 31(1): 34-40. doi: 10.1177/0885066614523918.
6. Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005; 33(10): 2184-93. doi: 10.1097/01.ccm.0000181731.53912.d9.
7. Sprindzhuk MV, Adzeriho IJe, Lapteva IM, Dergachev AV. Bronholegochnye oslozhnenija v kardiohirurgii. Novosti hirurgii. 2008; 16(2): 149-157. (In Russ).
8. Riera M, Ibáñez J, Herrero J, et al. Respiratory tract infections after cardiac surgery: impact on hospital morbidity and mortality. J Cardiovasc Surg (Torino). 2010; 51(6): 907-14.
9. Mitrofanova NN, Mel’nikov VL, Babaev SJu, Zhuravlev RV. Ecological and epidemiological features of nosocomial infections in department of thoracic surgery multidisciplinary hospital. Fundamental’nye issledovanija. 2014; 7-3: 540-3. (In Russ).
10. Kunal S, Vishal K, Deepak KS. Mediastinitis in cardiac surgery: A review of the literature. Int J Med Biomed Res 2012; 1(2): 97-103. doi: 10.14194/ ijmbr.123.
11. Rehman SM, Elzain O, Mitchell J, et al. Risk factors for mediastinitis following cardiac surgery: the importance of managing obesity. J Hosp Infect. 2014; 88(2): 96-102. doi: 10.1016/j.jhin.2014.06.011.
12. Petitpas F, Blancal JP, Mateo J, et al. Factors associated with the mediastinal spread of cervical necrotizing fasciitis. Ann Thorac Surg. 2012; 93(1): 234-8. doi: 10.1016/j.athoracsur.2011.09.012.
13. Kireeva EM, Romanov MD, Tishenkov DA. Local sanation of patients with acute pleural empyema: opportunities and prospects. Nauchnoe obozrenie. Medicinskie nauki. 2016; (3): 62-70. (In Russ).
14. Sugarbaker DJ, Bueno R, Colson YL, et al. Adult Chest Surgery. 2nd ed. In: Overview of benign lung disease: anatomy and Pathophysiology. Mc Graw Hill Education; 2015. p.744-51. doi: 10.13140/RG.2.1.2530.1204.
15. Bennett J, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2019.
16. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections. Healthcare Infection Control Practices Advisory Committee; 2017.
17. Hansen S, Schwab F, Schneider S, et al. Time-series analysis to observe the impact of a centrally organized educational intervention on the prevention of central-line-associated bloodstream infections in 32 German intensive care units. J Hosp Infect. 2014; 87(4): 220-6. doi: 10.1016/ j.jhin.2014.04.010.
18. Lytkin MI, Kostin ED, Kostyuchenko AL, Tereshin IM. Septicheskij shok. L.: Medicina; 1980. p. 240. (In Russ).
19. Zalacain R, Torres A, Celis R, et al. Community-acquired pneumonia in the elderly: Spanish multicentre study. Eur Respir J. 2003; 21(2): 294-302. doi: 10.1183/09031936.03.00064102.
20. Chuchalin AG, Sinopal’nikov AI, Strachunskij LS, et al. Nozokomial’naja pnevmonija u vzroslyh: prakticheskie rekomendacii po diagnostike, lecheniju i profilaktike. Posobie dlja vrachej. Pul’monologija. 2005; 3: 13-36. (In Russ). doi: 10.18093/ 0869-0189-2005-0-3-13-36.
21. Rautaporras N, Furuholm J, Uittamo J, et al. Deep odontogenic infections-identifying risk factors for nosocomial pneumonia. Clin Oral Investig. 2021; 25(4): 1925-32. doi: 10.1007/s00784-020-03500-4.
22. Gel’fand BR, Belocerkovskij BZ, Procenko DN, et al. Nozokomial’naja pnevmonija v hirurgii: Metod. rekomendacii. M.: RASHI, 2003. 19 p. (In Russ).
23. Shevchenko AA, Topalov KP, Zhila NG, Kashkarov EA. Surgical treatment of sternal osteomyelitis and sternomediastinitis following cardiac surgery. Hirurgija. Zhurnal im. N.I. Pirogova. 2021; 9: 34-9. (In Russ). doi: 10.17116/hirurgia202109134.
24. Hubmayr RD, Burchardi H, Elliot M, et al. Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia-Chicago, Illinois, May 2002. Intensive Care Med. 2002; 28(11): 1521-36. doi: 10.1007/s00134-002-1514-0.
25. Dries DJ, McGonigal MD, Malian MS, et al. Protocol-driven ventilator weaning reduces use of mechanical ventilation, rate of early reintubation, and ventilator-associated pneumonia. J Trauma. 2004; 56(5): 943-51; discussion 951-2. doi: 10.1097/01.ta.0000124462.61495.45.
26. Altintas ND, Aydin K, Türkoğlu MA, et al. Effect of enteral versus parenteral nutrition on outcome of medical patients requiring mechanical ventilation. Nutr Clin Pract. 2011; 26(3): 322-9. doi: 10.1177/0884533611405790.
27. Großmann J, Schulz-Stübner S. Nosokomiale Pneumonien. Dtsch Med Wochenschr. 2020; 145(6): 371-382. German. doi: 10.1055/a-0993-1078.
28. Dumville JC, McFarlane E, Edwards P, et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev. 2015; 2015(4): CD003949. doi: 10.1002/14651858.CD003949.pub4.
29. Ling ML, Apisarnthanarak A, Abbas A, et al. APSIC guidelines for the prevention of surgical site infections. Antimicrob Resist Infect Control. 2019; 8: 174. doi: 10.1186/s13756-019-0638-8.
30. Korymasov EA, Pushkin SYu, Benyan AS, Medvedchikov-Ardiya MA. Post-sternotomy infectious complications: surgical treatment strategy and tactics. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2015; 2(4): 15-25. (In Russ). doi: 10.17650/2408-9613-2015-2-4-15-25.
31. Cherniavskiy AM, Tarkova AR, Ruzmatov TM, et al. Infections in cardiac surgery. Pirogov Russian Journal of Surgery. 2016; 5:64-8. (In Russ). doi: 10.17116/hirurgia2016564-68.
32. Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012; 13(4): 234-7. doi: 10.1089/sur.2012.131.
33. Kazachek JaV, Pomeshkina SA, Barbarash OL. Prevention of infectious complications in cardiac surgery. Kompleksnye problemy serdechno-sosudistyh zabolevanij. 2014; 4: 62-9. (In Russ).
34. Shevchenko JuL, Nemchenko VI, Makarov AA. Infekcionnye oslozhnenija operacij na serdce s iskusstvennym krovoobrashheniem. Aktual’nye problemy gnojno-septicheskih infekcij. SPb.: Nauka; 1996. (In Russ).
35. Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011; 114(2): 283-92. doi: 10.1097/ALN.0b013e3182054d06.
36. Shevchenko JuL, Danil’chenko VV, Zhiburt EB, et al. K probleme posttransfuzionnoj immunosupressii. Voenno-medicinskij zhurnal. 1996; 317(10): 22-5. (In Russ).
37. Shevchenko JuL, Zhiburt EB, Bel’gesov NV, Serebrjanaja NB. Infekcionnaja bezopasnost’ gemotransfuzionnoj terapii. Mezhdunarodnye medicinskie obzory. 1995; 3(2): 91-4. (In Russ).
38. Shevchenko JuL, Zhiburt EB, Serebrjanaja NB. Immunologicheskaja i infekcionnaja bezopasnost’ gemokomponentnoj terapii. SPb.: Nauka; 1998. p.227. (In Russ).
39. Stokes ME, Ye X, Shah M, et al. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients. BMC Health Serv Res. 2011; 11: 135. doi: 10.1186/1472-6963-11-135.
40. Shevchenko JuL, Fadeev NP, Matveev SA, et al. Sovremennaja metodika diagnostiki proteznogo jendokardita. Sovremennye tehnologii diagnostiki i terapii infekcionnyh boleznej. SPb.: Nauka; 1999. (In Russ).
41. Shevchenko JuL. Hirurgicheskoe lechenie infekcionnogo jendokardita i osnovy gnojno-septicheskoj kardiohirurgii. 2nd ed. M.: Dinastija; 2020. p.448. (In Russ).
42. Hirurgicheskie infekcii kozhi i mjagkih tkanej: Rossijskie nacional’nye rekomendacii. B.R. Gel’fand, editor. M.: Medicinskoe informacionnoe agentstvo; 2015. 111 p. (In Russ).
43. Yusupov AI, Vitsukaev VV, Zakharevich VM. Bilateral internal thoracic artery grafting for on-pump coronary artery bypass surgery. Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2020; 13(1): 56-63. (In Russ). doi: 10.17116/kardio20201301156.
44. Surat G, Bernsen D, Schimmer C. Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections. J Cardiothorac Surg. 2021; 16(1): 309. doi: 10.1186/s13019-021-01693-7.
45. Gelijns AC, Moskowitz AJ, Acker MA, et. al. Management practices and major infections after cardiac surgery. J Am Coll Cardiol. 2014; 64(4): 372-81. doi: 10.1016/j.jacc.2014.04.052.
46. Rupp ME, Karnatak R. Intravascular Catheter-Related Bloodstream Infections. Infect Dis Clin North Am. 2018; 32(4): 765-787. doi: 10.1016/ j.idc.2018.06.002.
47. Sahasrabudhe PB, Pradhan MD, Panse N, Jagtap R. Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center. Indian J Plast Surg. 2021; 54(2): 157-162. doi: 10.1055/s-0041-1731256.
48. Waked K, Ballaux P, Goossens D, Cathenis K. The ‘Two Bridges Technique’ for sternal wound closure. The use of vacuum-assisted closure for the treatment of deep sternal wound defects: a centre-specific technique. Int Wound J. 2018; 15(2): 198-204. doi: 10.1111/iwj.12823.
49. Agarwal JP, Wu LC, Wu LC, et al. Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach. Plast Reconstr Surg. 2005; 116(4): 1035-40. doi: 10.1097/01.prs.0000178401.52143.32.
50. Yadav S, Rawal G, Baxi M. Vacuum assisted closure technique: a short review. Pan Afr Med J. 2017; 28: 246. doi: 10.11604/pamj.2017.28.246.9606.
51. Tseimakh EA, Levin AV, Shvetsov IV, Broder IA. Application of endobronchial valve occlusion and videothoracoscopy in complex treatment of pyopneumothorax. Endoscopic Surgery. 2011; 17(2): 14-7. (In Russ).
52. Matveev VJu, Hasanov RM, Gajfullin RF, et al. Сombination surgical treatment of pleural empyema pleura using video-assisted thoracoscopy. Prakticheskaja medicina. 2021; 2(8): 111-16. (In Russ).
53. Chan DT, Sihoe AD, Chan S, et al. Surgical treatment for empyema thoracis: is video-assisted thoracic surgery “better” than thoracotomy? Ann Thorac Surg. 2007; 84(1): 225-31. doi: 10.1016/j.athoracsur.2007.03.019.