Sternal Wound Infection after Cardiac Surgery: Management and Outcome.

Sternal Wound Infection (SWI) is a severe complication after cardiac surgery. Debridement associated with primary closure using Redon drains (RD) is an effective treatment, but data on RD management and antibiotic treatment are scarce.We performed a single-center analysis of consecutive patients who were re-operated for SWI between 01/2009 and 12/2012. All patients underwent a closed drainage with RD (CDRD). Patients with endocarditis or those who died within the first 45 days were excluded from management analysis. RD fluid was cultured twice weekly. Variables recorded were clinical and biological data at SWI diagnosis, severity of SWI based on criteria for mediastinitis as defined by the Centers for Disease Control (CDC), antibiotic therapy, RD management and patient's outcome.160 patients developed SWI, 102 (64%) fulfilled CDC criteria (CDC+) and 58 (36%) did not (CDC- SWI). Initial antibiotic treatment and surgical management were similar in CDC+ and CDC- SWI. Patients with CDC+ SWI had a longer duration of antibiotic therapy and a mortality rate of 17% as compared to 3% in patients with CDC- SWI (p = 0.025). Rates of superinfection (10% and 9%) and need for second reoperation (12% and 17%) were similar. Failure (death or need for another reoperation) was associated with female gender, higher EuroScore for prediction of operative mortality, and stay in the ICU.In patients with SWI, initial one-stage surgical debridement with CDRD is associated with favorable outcomes. CDC+ and CDC- SWI received essentially the same management, but CDC+ SWI has a more severe outcome

Variables Associated with Failure (n = 36), Cox Proportional Hazard Model.

<p>Abbreviation: HR, Hazard ratio; BMI, Body Mass Index; SWI, CABG, Coronary Artery Bypass Grafting; SWI, Sternal Wound Infection; <i>S</i>. <i>aureus</i>, <i>Staphylococcus aureus</i>, CoNS, coagulase-negative staphylococci; CDC, Centers for Diseases control and Prevention; ICU, Intensive care unit</p><p>Variables Associated with Failure (n = 36), Cox Proportional Hazard Model.</p

Surgical and Medical Management in 137 Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery according to the Definition.

<p>Surgical and Medical Management in 137 Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery according to the Definition.</p

Microbiological Data in 160 Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery, n (%).

<p>Abbreviation: MRSA, Methicillin-resistant staphylococcus aureus; CoNS, Coagulase-negative staphylococci</p><p>Microbiological Data in 160 Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery, n (%).</p

Flow chart of Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery.

<p>Flow chart of Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery.</p

Initial Presentation of 160 Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery.

<p>* The two last modalities were brought together for the test because the conditions of validity for a Chi-square test at 3 degrees of freedom were not verified</p><p>Initial Presentation of 160 Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery.</p

Santé au travail : regards sociologiques

La santé au travail fait l'objet d’un intérêt renouvelé dans l'espace public, avec la dégradation des indicateurs de la santé au travail, les transformations des expressions des pénibilités du travail, ainsi qu’avec la crise et les recompositions du système institué de santé au travail. Ce Corpus témoigne de l’apport du regard sociologique à la compréhension des dimensions sociales de ces phénomènes, trop souvent laissées dans l’ombre par les autres disciplines. Le genre est ainsi une des clés de lecture centrale des processus d’invisibilisation des liens travail-santé. Il peut aussi être au principe d’une mobilisation syndicale effective. Sont également examinés la manière dont des salariés dont la santé est fragilisée par des processus largement étrangers aux risques professionnels doivent faire avec cette donnée dans le monde du travail, les conditions sociales de l’entrée en lutte de groupes de travailleurs initialement peu prédisposés à interroger les sources professionnelles de leur santé, les agriculteurs, les efforts des sociologues anglo-saxons pour tenter d’extraire la notion de stress du tropisme des approches psychologisantes ou médicalisantes