Impact of Diabetes and Blood Glucose Control on Surgical Site Infections in Cardiac Surgery

Öz

Introduction: Surgical site infection is an important morbidity in cardiac surgery. Purpose of this study is to compare surgical site infections after surgery in our center in diabetic and non-diabetic patients. Patients and Methods: Surgical site infections and the responsible microorganisms after cardiac operations from January to December 2011 were documented. Patients were aligned in to four Groups; 16 patients with known diabetes were Group I, 22 patients with preoperative hyperglycemia but without known diabetes were Group II, 8 patients with postoperative hyperglycemia were Group III and 14 patients with normal pre and postoperative blood glucose levels were Group IV. Infections were classifi ed according to Centers for Disease Control and Prevention (CDC) guidelines. Results: Surgical wound infections were detected in 60 patients. Organ/space type surgical infections were more common in Group I and III, compared to patients in Group II and IV, among whom, deep wound infections were more common. Methicillin resistant Staphylococcus aureus and Acinetobacter baumannii were more prominant in Group II and III, where as Klebsiella spp. and Serratia spp. Were more common in Group I patients. Mortality rate was highest in Group II (59%), followed by Group I (38%). Mortality in Group III was 25% and 21.4% in Group IV, with a statistically important difference compared to Group II (p= 0.02). Conclusion: High blood glucose level that can not be regulated in preoperative and postoperative periods, is an important risk factor for surgical site infections. Strict control of blood glucose levels in diabetic patients, is believed to decrease infection prevalence and asssociated hospital mortality.

Anahtar Kelimeler

• Diabetes mellitus, blood glucose, surgical wound infection

Açık Kalp Cerrahisi Hastalarında Diyabet ve Kan Glukozu Kontrolünün Cerrahi Alan Enfeksiyonları Üzerine Etkisi*

Öz

9 ÖZET Giriş: Kardiyak operasyonlar sonrasında cerrahi alan enfeksiyonları önemli bir morbiditedir. Diyabetik hastalarda enfeksiyona eğilim artmaktadır. Bu çalışmanın amacı; merkezimizde operasyon sonrası görülen cerrahi alan enfeksiyonlarını, diyabetik olan ve olmayan hastalarda karşılaştırmaktır. Hastalar ve Yöntem: Ocak-Aralık 2011 tarihleri arasında, kalp cerrahisi sonrası görülen cerrahi alan enfeksiyonları ve üreyen mikroorganizmalar kaydedilmiştir. Diyabet tanısı olan 16 hasta Grup I, diyabet tanısı olmayan, preoperatif hiperglisemik çıkan 22 hasta Grup II, postoperatif hiperglisemi tespit edilen 8 hasta Grup III ve kan şekerleri normal seyreden 14 hasta Grup IV olarak belirlenmiştir. Enfeksiyonlar "Centers for Disease Control and Prevention (CDC)" kılavuzuna göre sınıfl andırılmıştır. Bulgular: Yara yeri enfeksiyonu 60 hastada tespit edilmiştir. Grup I ve Grup III'te organ/boşluk tipi enfeksiyon sık görülürken, Grup II ve Grup IV'te derin insizyonel enfeksiyon daha sık görülmüştür. Gruplara göre üretilen suşların dağılımına bakıldığında, Grup II ve Grup III'te daha çok metisiline dirençli Staphylococcus aureus ve Acinetobacter baumannii suşlarının ön planda ürediği görülürken, Grup I'de çoğunlukla Klebsiella spp. ve Serratia spp. üremeleri olmuştur. En yüksek mortalite %59 ile Grup II'de görülmüş, bunu %38'lik mortalite hızı ile Grup I izlemiştir. Grup III (%25) ve Grup IV (%21.4) mortaliteleri, Grup II ile karşılaştırıldığında fark istatistiksel olarak anlamlı çıkmıştır (p= 0.02).Sonuç: Preoperatif ve postoperatif dönemde kontrol altına alınamayan yüksek kan glukoz seviyesi yara yeri enfeksiyonları açısından önemli bir risk faktörüdür. Diyabetik hastalarda kan glukoz seviyesi kontrolünün sağlanmasıyla enfeksiyon ve buna bağlı hastane mortalitesinin azalacağı düşünülmektedir.

Anahtar Kelimeler

• Diyabet, kan glukoz, cerrahi yara enfeksiyonu

Kaynakça

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