Information de reference pour ce titreAccession Number: | 00004848-200110000-00002.
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Author: | Latham, Robert MD; Lancaster, Ava D. RN; Covington, Janet F. RN; Pirolo, John S. MD; Thomas, Clarence S. Jr MD
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Institution: | From the Department of Medicine, Vanderbilt University (Dr. Latham); Hospital Epidemiology, Saint Thomas Hospital (Dr. Latham, Ms. Lancaster, and Ms. Covington); and Cardiovascular Surgical Associates, Saint Thomas Heart Institute, Saint Thomas Hospital (Drs. Pirolo and Thomas), Nashville, Tennessee.
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Title: | THE ASSOCIATION OF DIABETES AND GLUCOSE CONTROL WITH SURGICAL-SITE INFECTIONS AMONG CARDIOTHORACIC SURGERY PATIENTS.[Article]
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Source: | Infection Control & Hospital Epidemiology. 22(10):607-612, October 2001.
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Abstract: | OBJECTIVE: To assess the importance of diabetes, diabetes control, hyperglycemia, and previously undiagnosed diabetes in the development of surgical-site infections (SSIs) among cardiothoracic surgery patients.
SETTING: A 540-bed tertiary-care university-affiliated hospital.
DESIGN: Prospective cohort and case-control studies.
PATIENTS: All patients having cardiothoracic surgery between November 1998 and September 1999 were eligible for participation. One thousand patients had preoperative hemoglobin A1c determinations. Seventy-four patients with SSIs were identified.
RESULTS: Diabetes (odd ratio [OR], 2.76; P<=.001) and postoperative hyperglycemia (OR, 2.02; P=.007) were independently associated with development of SSIs. Among known diabetics, elevated hemoglobin A1c values were not associated with a statistically significantly increased risk of infection; the mean A1c value was 8.44% among those with infections compared with 7.80% for those without (P=.09). Forty-two (6%) of 700 patients without prior diabetes history had evidence of undiagnosed diabetes; their infection rate was comparable to that of known diabetics (3/42 [7%] vs 17/300 [6%]; P=.72). An additional 30% of nondiabetics had elevated hemoglobin A1c determinations or perioperative hyperglycemia.
CONCLUSIONS: Postoperative hyperglycemia and previously undiagnosed diabetes are associated with development of SSIs among cardiothoracic surgery patients. Screening for diabetes and hyperglycemia among patients having cardiothoracic surgery may be warranted to prevent postoperative and chronic complications of this metabolic abnormality.
Copyright (C) 2001. University of Chicago Press.
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References: | 1. Zacharias A, Habib RH. Factors predisposing to median sternotomy complications: deep vs superficial infection. Chest 1996;110:1173-1178.
2. Vuorisalo S, Haukipuro K, Pokela R, Syrjala H. Risk features for surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol 1998;19:240-247.
3. Slaughter MS, Olson MM, Lee JT Jr, Ward HB. A fifteen-year wound surveillance study after coronary artery bypass. Ann Thorac Surg 1993;56:1063-1068.
4. Nagachinta T, Stephens M, Reitz B, Polk B. Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis 1987;156:967-973.
5. Lillenfeld D, Engin M, Vlahov D, Tenney J, McLaughlin J. Obesity and diabetes as risk factors for postoperative wound infections after cardiac surgery. Am J Infect Control 1988;16:3-6.
6. Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998;65:1050-1056.
7. Baxter J, Babineau B, Apovian C, et al. Perioperative glucose control predicts increased nosocomial infection in diabetics. Crit Care Med 1990;18(suppl):S207. Abstract.
8. Pomposelli JJ, Baxter JK 3rd, Babineau TJ, Pomfret EA, Driscoll DF, Forse RA, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr 1998;22:77-81.
9. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetics on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-986.
10. Harris M, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: the Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998;21:518-524.
11. Levetan C, Passo M, Jasblonski K, Kass M, Ratner R. Unrecognized diabetes among hospitalized patients. Diabetes Care 1998;21:246-249.
12. Emori TG, Culver DH, Horan TC, Jarvis WR, White JW, Olson DR, et al. National Nosocomial Infections Surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19-35.
13. Horan T, Gaynes R, Martone W, Jarvis W, Emori T. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13:606-608.
14. Abbott Laboratories. IMx System: Glycated Hemoglobin. Package insert. Abbott Park, IL: Abbott Laboratories; 1994.
15. Peters A, Davidson M, Schriger D, Hasselblad V. A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. JAMA 1996;276:1246-1252.
16. Schlesselman JJ. Case-Control Studies: Design, Conduct, Analysis. New York, NY: Oxford University Press; 1982:203-206.
17. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1998;21:S5-S19.
18. Davidson M, Schriger D, Peters A, Lorber B. Relationship between fasting plasma glucose and glycosylate hemoglobin: potential for false-positive diagnoses of type 2 diabetes using new diagnostic criteria. JAMA 1999;281:1203-1210.
19. Husband DJ, Alberti KG, Julian DG. "Stress" hyperglycaemia during acute myocardial infarction: an indicator of pre-existing diabetes? Lancet 1983;2:179-181.
20. Gerstein HC. Glucose: a continuous risk factor for cardiovascular disease. Diabet Med 1997;14(suppl 3):S25-S31.
21. McMahon M, Bistrian B. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 1995;9:1-9.
22. Bagdade JD, Stewart M, Walters E. Impaired granulocyte adherence: a reversible defect in host defense in patients with poorly controlled diabetes. Diabetes 1978;27:677-681.
23. Mowat A, Baum J. Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus. N Engl J Med 1971;284:621-627.
24. Delamaire M, Maugendre D, Moreno M, LeGoff M, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med 1996;14:29-34.
25. Alecxiewicz J, Kumar D, Smogorzewski M, Klin M, Massey S. Polymorphonuclear leukocytes in non-insulin-dependent diabetes mellitus: abnormalities in metabolism and function. Ann Intern Med 1995;123:919-924.
26. MacRury SM, Gemmell CG, Paterson KR, MacCuish AC. Changes in phagocytic function with glycaemic control in diabetic patients. J Clin Pathol 1989;42:1143-1147.
27. Nielson CP, Hindson DA. Inhibition of polymorphonuclear leukocyte respiratory burst by elevated glucose concentrations in vitro. Diabetes 1989;38:1031-1035.
28. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997;63:356-361.
29. Furnary A, Zerr K, Grunkemeier G, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999;67:352-362.
30. Krolewski A, Laffel L, Krolewski B, Quin M, Warram J. Glycosylated hemoglobin and the risk of microalbuminuria in patients with insulin-dependent diabetes mellitus. N Engl J Med 1995;332:1251-1255.
31. Haffner S. Epidemiological studies on the effects of hyperglycemia and improvement of glycemic control on macrovascular events in type 2 diabetes. Diabetes Care 1999;2:C54-C56.
32. American Diabetes Association. Screening for type 2 diabetes. Diabetes Care 1999;22:S20-S23.
33. CDC Diabetes Cost-Effectiveness Study Group. The cost-effectiveness of screening for type 2 diabetes. JAMA 1998;280:1757-1763.
34. Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenstrom A, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality a 1 year. J Am Coll Cardiol 1995;26:57-65.
35. Malmberg K, Ryden L, Hamsten A, Herlitz J, Waldenstrom A, Wendel H. Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. DIGAMI Study Group. Eur Heart J 1996;17:1337-1344.
36. Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ 1997;314:1512-1515.
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Language: | English.
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Document Type: | ORIGINAL ARTICLES.
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Journal Subset: | Clinical Medicine. Public Health.
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ISSN: | 0899-823X
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NLM Journal Code: | ich, 8804099
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Annotation(s) | |
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