Ann Thorac Surg 2005;80:384
© 2005 The Society of Thoracic Surgeons
Correspondence
Reply
Cely S. Abboud, MD, MS,
Sérgio B. Wey, MD, PhD,
Valéria T. Baltar, MS
Instituto Dante Pazzanese de Cardiologia, Av Dr. Dante Pazzanese, 500, Sâo Paulo, SP 04012-180 Brazil
(Email: csa3{at}terra.com.br).
To the Editor:
We would like to congratulate Grando and co-workers for their comments about the prophylactic antibiotic dosage in cardiac surgery.
We analyzed 10 studies in our revision. In five of these studies we found obesity as being a risk factor for mediastinitis [1–5].
We do believe that the risk factors of mediastinitis after cardiac surgery are multifactorial. In our study, the independent risk factors found were obesity (odds ratio [OR], 6.49; 95% confidence interval, 2.24 to 18.78), smoking (OR, 3.27; 95% confidence interval, 1.04 to 10.20) intensive care unit stay more than 2 days (OR, 4.5; 95% confidence interval, 1.57 to 12.9), and infection at another site (OR, 8.86; 95% confidence interval, 1.86 to 42.27).
We agree with Grando and colleagues that that the adjustment of prophylactic antibiotics to the patient weight > 70 Kg is a very good intervention to reduce the incidence of this catastrophic infection, because the only risk factor found was weight > 75 Kg.
It is also important to know the bacterial flora and their susceptibility to cefazolin, because there was a reduction of mediastinitis in patients that have infection due to susceptible agents.
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References
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- Abboud CS, Wey SB, Baltar VT. Risk factors for mediastinitis after cardiac surgery Ann Thorac Surg 2004;77:676-683.[Abstract/Free Full Text]
- Bitcover CY, Gardlund B. Mediastinitis after cardiovascular operationsa case-control study of risk factors. Ann Thorac Surg 1998;65:36-40.[Abstract/Free Full Text]
- The Parisian Mediastinitis Study Group Risk factors for deep sternal wound infection after sternotomya prospective, multicenter study. J Thorac Cardiovasc Surg 1996;111:1200-1207.[Abstract/Free Full Text]
- Milano CA, Kesler K, Archibald N, et al. Mediastinitis after coronary artery bypass graft surgery Circulation 1995;92:2245-2251.[Abstract/Free Full Text]
- Nagachinta T, Stephens M, Reitz B, et al. Risk factors for surgical wound infection following cardiac surgery J Infect Dis 1987;156(6):967-973.[Medline]
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