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  • 1.
    Ahlsson, Anders
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Källman, Jan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    An angry cat causing Pasteurella multocida endocarditis and aortic valve replacement: A case report2016In: International journal of surgery case reports, ISSN 2210-2612, E-ISSN 2210-2612, Vol. 24, p. 91-93Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Cat bite infections usually involve a mix of anaerobic and aerobic bacteria including species of Pasteurella, Streptococcus, Staphylococcus, Bacteroides, and Fusobacterium. We report a case of Pasteurella multocida infection from cat bites leading to endocarditis and subsequent aortic valve replacement.

    PRESENTATION OF CASE: A 70-year-old male was admitted because of fever, tachycardia, and malaise. He had a history of alcohol abuse and was living alone with a cat in a rural area. A sepsis of unknown origin was suspected, and intravenous treatment with gentamicin and cefotaxime was initiated. Blood cultures yielded Pasteurella multocida, and the patient history revealed repeated cat bites. After four days, the patient was discharged with oral penicillin V treatment. Two weeks later, the patient returned with fever and a new systolic murmur. An aortic valve endocarditis was diagnosed, and it became clear that the patient had not completed the prescribed penicillin V treatment. The patient underwent a biological aortic valve replacement with debridement of an annular abscess, and the postoperative course was uneventful.

    DISCUSSION: Endocarditis due to Pasteurella is extremely rare, and there are only a few reports in the literature. Predisposing factors in the present case were alcohol abuse and reduced compliance to treatment.

    CONCLUSION: Cat bites are often deep, and in rare circumstances can lead to life-threatening endocarditis. Proper surgical revision, antibiotic treatment, and patient compliance are necessary components in patient care to avoid this complication.

  • 2.
    Alström, Ulrica
    et al.
    Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
    Granath, Fredrik
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic Surgery.
    Ekbom, Anders
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Ståhle, Elisabeth
    Department of Cardiothoracic Surgery and Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
    Risk factors for re-exploration due to bleeding after coronary artery bypass grafting2012In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 46, no 1, p. 39-44Article in journal (Refereed)
    Abstract [en]

    Objective: The study aimed to investigate relevant clinical risk factors for re-exploration due to bleeding after primary coronary artery bypass graft (CABG) surgery, and to evaluate the influence of antiplatelet and antifibrinolytic drugs.

    Design: Three retrospective analyses were performed on patients who underwent CABG: (1) Logistic regression was used to identify clinical risk factors for re-exploration (n = 3000). (2) A case-control study (n = 228) was used to obtain information on exposure of antithrombotic and hemostatic therapy. (3) Based on exposure to antiplatelet and antifibrinolytic therapy, and odds ratios (ORs) in multivariate logistic models, the proportion of re-explorations attributed to these drugs was calculated.

    Results: A receiver operating characteristic curve was created for clinical risk factors. The C-index was 0.64, indicating limited ability to predict re-exploration for bleeding. Clopidogrel was the only drug influencing the risk of re-exploration (OR 3.2, 95% CI 1.7-5.9). The harmful effect of clopidogrel was confirmed in multivariate model (OR 4.7, 95% CI 2.2-9.9), and aprotinin had a protective effect of the same magnitude (OR 0.2, 95% CI 0.1-0.6).

    Conclusions: Clopidogrel is an essential risk factor for re-exploration due to bleeding, and attributable to at least one-quarter of surveyed cases. Aside from pharmaceuticals, there are no strong clinical risk factors.

  • 3.
    Damén, Tor
    et al.
    Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Sunnermalm, Lena
    Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Zagozdzon, Leszek
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Cederstrand, Bo
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Kellert, Tomas
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Inverted valve after initially successful transfemoral aortic valve implantation2012In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 94, no 2, p. 636-639Article in journal (Refereed)
    Abstract [en]

    A 73-year-old woman with severe aortic stenosis was accepted for transcatheter aortic valve implantation. There was minimal paravalvular leakage after the implantation, and the patient was stable. Twelve minutes after the implantation, the arterial pressure suddenly dropped. Transesophageal echocardiography showed severe left ventricular dysfunction. Cardiopulmonary resuscitation was started, and initially was successful with a systolic blood pressure of 90 mm Hg. However, despite initiation of extracorporeal circulation support, the patient deteriorated, pulmonary edema developed, and she died. Autopsy revealed an inverted aortic valve. The reasons why the patient had cardiac arrest and an inverted transfemoral aortic valve remain unclear.

  • 4.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden; .
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences; Department of Nursing, Umeå University, Umeå, Sweden.
    Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes2013In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 15, no 2, p. 242-248Article in journal (Refereed)
    Abstract [en]

    Surgical site contamination, for example, with coagulase-negative staphylococci, probably derives from both the patient’s own skin flora and those of the surgical team. Despite preoperative antiseptic preparation with chlorhexidine solution, complete sterilization of the skin is not possible and gradual recolonization will occur. Plastic adhesive drape is an established method used to prevent direct wound contamination from adjacent skin. In this study, the time to skin recolonization after antiseptic preparation was measured and the impact of using plastic adhesive drape on this recolonization was evaluated. Repeated bacterial sampling using three different methods over 6 hr was conducted after antiseptic preparation in 10 volunteers. Recolonization of skin was observed after 30 min with plastic drape and after 60 min without plastic drape; there were significantly more positive cultures with the plastic drape than without (31% vs. 7.5%, respectively, p < .001). Sampling with a rayon swab was the most sensitive sampling method. In conclusion, covering the skin with a plastic adhesive drape seems to hasten recolonization of the skin after antiseptic preparation. However, clinical trials to confirm this finding are warranted.

  • 5.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology ,Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial sealant2014In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 33, no 11, p. 1981-1987Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n = 68) and the microbial skin sealant group (n = 67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p = 0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site.

  • 6.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Region Örebro County, Örebro, Sweden.
    Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin2013In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 84, no 2, p. 151-158Article in journal (Refereed)
    Abstract [en]

    Background: Sternal wound infection after cardiac surgery is a serious complication. Various perioperative strategies, including plastic adhesive drapes, are used to reduce bacterial contamination of surgical wounds.

    Aim: To compare plastic adhesive drape to bare skin regarding bacterial growth in wound and time to recolonization of the adjacent skin intraoperatively, in cardiac surgery patients.

    Methods: This single-blinded randomized controlled trial (May 2010 to May 2011) included 140 patients scheduled for cardiac surgery via median sternotomy. The patients were randomly allocated to the adhesive drape (chest covered with plastic adhesive drape) or bare skin group. Bacterial samples were taken preoperatively and intraoperatively every hour during surgery until skin closure.

    Results: Disinfection with 0.5% chlorhexidine solution in 70% alcohol decreased coagulase-negative staphylococci (CoNS), while the proportion colonized with Propionibacterium acnes was not significantly reduced and was still present in more than 50% of skin samples. P. acnes was significantly more common in men than in women. Progressive bacterial recolonization of the skin occurred within 2-3 h. At 120 min there were significantly more positive cultures in the adhesive drape group versus bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs 24%; P = 0.013). The only statistically significant difference in bacterial growth in the surgical wound was higher proportion of CoNS at the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).

    Conclusion: Plastic adhesive drape does not reduce bacterial recolonization. P. acnes colonized men more frequently, and was not decreased by disinfection with chlorhexidine solution in alcohol.

  • 7.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Response to MH Stevens and NM Klinger, re: Bacterial recolonization of the skin and wound contamination during cardiac surgery2013In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 85, no 4, p. 325-325Article in journal (Refereed)
  • 8.
    Friberg, Örjan
    et al.
    Dept Cardiovasc, Örebro University Hospital, Örebro, Sweden; Thorac Surg, Örebro University Hospital, Örebro, Sweden.
    Bodin, Lennart
    Inst Environm Med, Unit Intervention & Implementation Research, Karolinska Institute, Stockholm, Sweden.
    Collagen Gentamicin for Prevention of Sternal Wound Infection: Effective or Not?2013In: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 61, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    Background Prophylactic local application of collagen-gentamicin sponges for prevention of sternal wound infections (SWI) after cardiac surgery has been used routinely in risk patients for several years at our center. However, a recent US study failed to show a significant reduction in SWI with the prophylaxis. Therefore, a systematic reevaluation of the effect of local collagen gentamicin was conducted. Methods A complete follow-up of all cardiac surgery patients 2 months postoperatively was achieved. All SWIs were recorded. The effect of the prophylaxis was analyzed, and differences in risk factors were compensated for using multiple logistic regression analyses and Coarsened Exact Matching (CEM). Results A total of 950 patients were included. Established risk factors for SWI were confirmed. The use of collagen-gentamicin prophylaxis was independently associated with a highly significant reduction in SWI (odds ratio [OR] 0.30, 95% confidence interval 0.16 to 0.57; p < 0.001). Applying the more advanced statistical method, CEM indicated that the effect of the prophylaxis may be even greater. Conclusions The use of local collagen-gentamicin prophylaxis was associated with an approximately 70% reduction in the rate of SWI compared with standard intravenous antibiotic prophylaxis alone.

  • 9. Friberg, Örjan
    et al.
    Dahlin, Lars-Göran
    Källman, Jan
    Kihlström, Erik
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences.
    Svedjeholm, Rolf
    Collagen-gentamicin implant for prevention of sternal wound infection: long-term follow-up of effectiveness2009In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 9, no 3, p. 454-458Article in journal (Refereed)
    Abstract [en]

    In a previous randomized controlled trial (LOGIP trial) the addition of local collagen-gentamicin reduced the incidence of postoperative sternal wound infections (SWI) compared with intravenous prophylaxis only. Consequently, the technique with local gentamicin was introduced in clinical routine at the two participating centers. The aim of the present study was to re-evaluate the technique regarding the prophylactic effect against SWI and to detect potential shifts in causative microbiological agents over time. All patients in this prospective two-center study received prophylaxis with application of two collagen-gentamicin sponges between the sternal halves in addition to routine intravenous antibiotics. All patients were followed for 60 days postoperatively. From January 2007 to May 2008, 1359 patients were included. The 60-day incidences of any SWI was 3.7% and of deep SWI 1.5% (1.0% mediastinitis). Both superficial and deep SWI were significantly reduced compared with the previous control group (OR=0.34 for deep SWI, P<0.001). There was no increase in the absolute incidence of aminoglycoside resistant agents. The majority of SWI were caused by coagulase-negative staphylococci (CoNS). The incidence of deep SWI caused by Staphylococcus aureus was 0.07%. The results indicate a maintained effect of the prophylaxis over time without absolute increase in aminoglycoside resistance. (ClinicalTrials.gov NCT00484055).

  • 10. Friberg, Örjan
    et al.
    Källman, Jan
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences.
    Olcén, P.
    Introduction: [to prevention of surgical site infections in cardiac surgery]2007In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 115, no 9, p. 987-988Article in journal (Refereed)
  • 11. Friberg, Örjan
    et al.
    Svedjeholm, Rolf
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences.
    Treating sternal wound infections after cardiac surgery with an implantable gentamicin-collagen sponge2010In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 304, no 19, p. 2123-2124Article in journal (Refereed)
  • 12. Olsson, Emma
    et al.
    Friberg, Örjan
    Venizelos, Nikolaos
    Örebro University, School of Health and Medical Sciences.
    Koskela, Anita
    Örebro University, School of Health and Medical Sciences.
    Källman, Jan
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences.
    Coagulase-negative staphylococci isolated from sternal wound infections after cardiac surgery: attachment to and accumulation on sternal fixation stainless steel wires2007In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 115, no 2, p. 142-151Article in journal (Refereed)
    Abstract [en]

    Sternal wound infection (SWI) is a serious complication after cardiac surgery. Coagulase-negative staphylococci (CoNS) have been found to be the most common pathogen involved in this postoperative infection related to implanted foreign materials, i.e. sternal fixation wires made from stainless steel. In this study a rapid and simple assay was developed for studying attachment and accumulation of CoNS on stainless steel wires in vitro using [(3)H] thymidine. The method showed a potential to detect differences in the dynamics of the adherence patterns among various CoNS isolates. However, no differences in attachment and accumulation were found between isolates causing deep SWI after cardiac surgery and contaminant isolates. In addition, there were no differences in the distribution of the ica operon between the two groups, as determined by polymerase chain reaction (PCR). Nevertheless, the ability to produce biofilm was found to be present significantly more frequently among SWI isolates than among contaminants.

  • 13.
    Steingrimsson, S.
    et al.
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden; Fac Med, Landspitali Univ Hosp, Univ Iceland, Reykjavik, Iceland.
    Thimour-Bergstrom, L.
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Roman-Emanuel, C.
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Schersten, H.
    Sahlgrenska Univ Hosp, .
    Friberg, Örjan
    Örebro University Hospital. Dept Cardiothorac Surg, Örebro University Hospital, Örebro, Sweden.
    Gudbjartsson, T.
    Fac Med, Landspitali Univ Hosp, Univ Iceland, Reykjavik, Iceland.
    Jeppsson, A.
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden; Inst Med, Sahlgrenska Acad, Dept Mol & Clin Med, Univ Gothenburg, Gothenburg, Sweden.
    Triclosan-coated sutures and sternal wound infections: a prospective randomized clinical trial2015In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 34, no 12, p. 2331-2338Article in journal (Refereed)
    Abstract [en]

    Surgical site infection is a common complication following cardiac surgery. Triclosan-coated sutures have been shown to reduce the rate of infections in various surgical wounds, including wounds after vein harvesting in coronary artery bypass grafting patients. Our purpose was to compare the rate of infections in sternotomy wounds closed with triclosan-coated or conventional sutures. A total of 357 patients that underwent coronary artery bypass grafting were included in a prospective randomized double-blind single-center study. The patients were randomized to closure of the sternal wound with either triclosan-coated sutures (Vicryl Plus and Monocryl Plus, Ethicon, Inc., Somerville, NJ, USA) (n = 179) or identical sutures without triclosan (n = 178). Patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). The primary endpoint was the prevalence of sternal wound infection according to the Centers for Disease Control and Prevention (CDC) criteria. The demographics in both groups were comparable, including age, gender, body mass index, and rate of diabetes and smoking. Sternal wound infection was diagnosed in 43 patients; 23 (12.8 %) sutured with triclosan-coated sutures compared to 20 (11.2 %) sutured without triclosan (p = 0.640). Most infections were superficial (n = 36, 10.1 %), while 7 (2.0 %) were deep sternal wound infections. There were 16 positive cultures in the triclosan group and 17 in the non-coated suture group (p = 0.842). The most commonly identified main pathogens were Staphylococcus aureus (45.4 %) and coagulase-negative staphylococci (36.4 %). Skin closure with triclosan-coated sutures did not reduce the rate of sternal wound infection after coronary artery bypass grafting. (clinicaltrials.gov: NCT01212315).

  • 14.
    Söderquist, Bo
    et al.
    Örebro University, School of Health and Medical Sciences.
    Andersson, Mira
    Nilsson, Martin
    Nilsdotter-Augustinsson, Åsa
    Persson, Lennart
    Friberg, Örjan
    Jacobsson, Susanne
    Örebro University, School of Health and Medical Sciences.
    Staphylococcus epidermidis surface protein I (SesI): a marker of the invasive capacity of S. epidermidis?2009In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 58, no Pt 10, p. 1395-1397Article in journal (Refereed)
  • 15.
    Thimour-Bergstrom, Linda
    et al.
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Roman-Emanuel, Christine
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Schersten, Henrik
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Dept Cardiothorac Surg.
    Gudbjartsson, Tomas
    Dept Cardiothorac Surg, Landspitali Univ Hosp, Univ Iceland, Reykjavik, Iceland; Fac Med, Univ Iceland, Reykjavik, Iceland.
    Jeppsson, Anders
    Dept Cardiothorac Surg, Sahlgrenska Univ Hosp, Gothenburg, Sweden; Inst Med, Dept Mol & Clin Med, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial2013In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 44, no 5, p. 931-938Article in journal (Refereed)
    Abstract [en]

    The incidence of surgical site infection (SSI) after open vein harvesting in coronary artery bypass grafting (CABG) patients ranges in different studies between 2 and 20%. Triclosan is an antibacterial substance that reduces the growth of bacteria by inhibiting fatty acid synthesis. We hypothesized that wound closure with triclosan-coated sutures would reduce SSI after open vein harvesting. An investigator-initiated prospective randomized double-blind single-centre study was performed with 374 patients, randomized to subcutaneous and intracutaneous leg-wound closure with either triclosan-coated sutures (Vicryl Plus((R)) and Monocryl Plus((R)), Ethicon, Somerville, NJ, USA) (n = 184) or identical sutures without triclosan (n = 190) from the same manufacturer. All patients were followed up after 30 days (clinical visit) and 60 days (telephone interview). Primary endpoint was SSI within 60 days after surgery according to the definition of Center for Disease Control. Predefined secondary endpoints included culture-proven and antibiotic-treated SSI. The primary endpoint occurred in 23 patients (12.5%) with triclosan-coated sutures and in 38 patients (20.0%) in the group without triclosan (P = 0.0497, risk ratio 0.63, (95% confidence interval 0.39-1.00). Corresponding figures for culture-proven infections were 7.6 vs 12.1%, (P = 0.15), and for antibiotic-treated infections, 10.9 vs 18.4%, (P = 0.039). Staphylococcus aureus and coagulase-negative staphylococci were the most common pathogens in both groups. Insulin-treated diabetes and vein-harvesting time were associated with SSI after vein harvesting. Leg-wound closure with triclosan-coated sutures in CABG patients reduces SSIs after open vein harvesting. (ClinicalTrials.gov number NCT01212315).

  • 16.
    Vidlund, Mårten
    et al.
    Örebro University, School of Health and Medical Sciences.
    Holm, Jonas
    Linköping Heart Ctr, Dept Cardiothorac Surgery, Linköping Univ Hosp, Linköping, Sweden.
    Håkanson, Erik
    Linköping Heart Ctr, Dept Cardiothorac Anesthesia, Linköping Univ Hosp, Linköping, Sweden.
    Friberg, Örjan
    Dept Cardiothorac Surg & Anesthesia, Univ Hosp Örebro, Örebro, Sweden.
    Sunnermalm, Lena
    Dept Cardiothorac Surg & Anesthesia, Univ Hosp Örebro, Örebro, Sweden.
    Vanky, Farkas
    Linköping Heart Ctr, Dept Cardiothorac Surg, Linköping Univ Hosp, Linköping, Sweden.
    Svedjeholm, Rolf
    Linköping Heart Ctr, Dept Cardiothorac Surg, Linköping Univ Hosp, Linköping, Sweden.
    The S-100B substudy of the GLUTAMICS-trial: glutamate infusion not associated with sustained elevation of plasma S-100B after coronary surgery2010In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 29, no 3, p. 358-364Article in journal (Refereed)
    Abstract [en]

    Background & aimsConcerns have been raised about potential neurological injury related to exogenous glutamate. In cardiac surgery glutamate has been administered as a putative cardioprotective agent by cardioplegia or intravenous infusion. In the GLUTAMICS trial, in addition to surveillance of clinical neurological injuries, a prespecified subgroup was analyzed with regard to postoperative S-100B levels to detect potential subclinical neurological injury related to glutamate infusion.MethodsSixty-nine patients operated on for unstable coronary syndrome were randomized to intravenous infusion of glutamate (n=35) or saline (n=34) perioperatively. Plasma levels of S-100B were obtained on the third postoperative day.ResultsS-100B in the glutamate group and the control group were 0.079±0.034μg/L and 0.090±0.042μg/L respectively (p=0.245). There were no patients with stroke or mortality. Three patients in the control group and two in the glutamate group had postoperative confusion. These patients had significantly elevated S-100B compared with those without confusion (0.132±0.047vs 0.081±0.036μg/L; p=0.003). Overall, 21 patients had S-100B above reference level (≥0.10μg/L) and these patients had significantly more calcifications in the ascending aorta on epiaortic scanning.ConclusionsIntravenous glutamate infusion during surgery for unstable coronary artery disease did not initiate a sustained elevation of plasma S-100B. Thus, no evidence for subclinical neurological injury related to glutamate infusion was found. In contrast, postoperative elevation of plasma S-100B was linked to calcification of the ascending aorta and postoperative confusion.

  • 17.
    Vidlund, Mårten
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, University Hospital Örebro, Örebro, Sweden.
    Håkanson, Erik
    Division of Cardiovascular Medicine, Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping University, Linköping, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, University Hospital Örebro, Örebro University, Örebro, Sweden.
    Juhl-Andersen, Sören
    Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia Blekinge Hospital, Karlskrona, Sweden.
    Holm, Jonas
    Division of Cardiovascular Medicine, Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping University, Linköping, Sweden.
    Vanky, Farkas
    Division of Cardiovascular Medicine, Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping University, Linköping, Sweden.
    Sunnermalm, Lena
    Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, University Hospital Örebro, Örebro University, Örebro, Sweden.
    Borg, Jan-Olov
    Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia Blekinge Hospital, Karlskrona, Sweden.
    Sharma, Rajiv
    Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia Blekinge Hospital, Karlskrona, Sweden.
    Svedjeholm, Rolf
    Division of Cardiovascular Medicine, Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping University, Linköping, Sweden.
    GLUTAMICS: a randomized clinical trial on glutamate infusion in 861 patients undergoing surgery for acute coronary syndrome2012In: The Internet Journal of Thoracic and Cardiovascular Surgery, ISSN 1524-0274, Vol. 144, no 4, p. 922-930.e7Article in journal (Refereed)
    Abstract [en]

    Objective: Glutamate has been claimed to protect the heart from ischemia and to facilitate metabolic and hemodynamic recovery after ischemia. The GLUTAmate for Metabolic Intervention in Coronary Surgery trial investigated whether an intravenous glutamate infusion given in association with surgery for acute coronary syndrome could reduce mortality and prevent or mitigate myocardial injury and postoperative heart failure.

    Methods: In the present prospective, triple-center, double-blind study, 861 patients undergoing surgery for acute coronary syndrome were randomly assigned to an intravenous infusion of glutamate (n = 428) or saline (n = 433) perioperatively.

    Results: The incidence of the primary endpoint--a composite of 30-day mortality, perioperative myocardial infarction, and left ventricular heart failure at weaning from cardiopulmonary bypass-was 7.3% versus 5.8% (P = .41) in the glutamate and control groups, respectively. Patients with left ventricular failure at weaning from cardiopulmonary bypass had a shorter median intensive care unit stay (25 vs 92 hours; P = .02) if they were treated with glutamate. In patients with unstable angina (Canadian Cardiovascular Society class IV) undergoing isolated coronary artery bypass grafting (n = 458), the incidence of severe circulatory failure according to the prespecified criteria was significantly lower in the glutamate group (1.3% vs 6.9%; P = .004). On multivariate analysis, glutamate infusion was associated with a reduced risk of developing severe circulatory failure (odds ratio, 0.17; 95% confidence interval, 0.04-0.72; P = .02). A relative risk reduction exceeding 50% for developing severe circulatory failure was seen in most risk groups undergoing isolated coronary artery bypass grafting, with those with diabetes a notable exception.

    Conclusions: The primary endpoint did not differ significantly between the groups. The secondary outcomes and post hoc analyses warrant additional studies with regard to the potential beneficial effect of glutamate on postischemic myocardial recovery.

  • 18.
    Vidlund, Mårten
    et al.
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Tajik, Bashir
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Håkanson, Erik
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Holm, Jonas
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Vanky, Farkas
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Svedjeholm, Rolf
    Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
    Post hoc analysis of the glutamics-trial: intravenous glutamate infusion and use of inotropic drugs after cabg2016In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, no 1, article id 54Article in journal (Refereed)
    Abstract [en]

    Background: Intravenous glutamate reduced the risk of developing severe circulatory failure after isolated coronary artery bypass graft surgery (CABG) for acute coronary syndrome (ACS) in a double-blind randomised clinical trial (GLUTAMICS-ClinicalTrials.gov Identifier: NCT00489827 ). Here our aim was to study if glutamate was associated with reduced the use of inotropes.

    Methods: Post-hoc analysis of 824 patients undergoing isolated CABG for ACS in the GLUTAMICS-trial. ICU-records were retrospectively scrutinised including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively.

    Results: ICU-records were found for 171 out of 177 patients who received inotropes perioperatively. Only one fourth of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from cardiopulmonary bypass (CPB) or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolaemia). Except for a significantly lower use of epinephrine there were only trends towards lower need of other inotropes overall in the glutamate group. In patients treated with inotropes (glutamate n = 17; placebo n = 13) who fulfilled study criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34 ± 20 v 80 ± 77 h; p = 0.014) and the number of inotropes used (1.35 ± 0.6 v 1.85 ± 0.7; p = 0.047) were lower in the glutamate group.

    Conclusions: Intravenous glutamate was associated with a minor influence on inotrope use overall in patients undergoing CABG for ACS whereas a considerable and significant reduction was observed in patients with heart failure at weaning from CPB.

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