@article{SuratBernsenSchimmer2021,
  author    = {Surat, G{\"u}zin and Bernsen, Dominik and Schimmer, Christoph},
  title     = {Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections},
  series = {Journal of Cardiothoracic Surgery},
  volume    = {16},
  journal   = {Journal of Cardiothoracic Surgery},
  doi       = {10.1186/s13019-021-01693-7},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265533},
  year      = {2021},
  abstract  = {Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital's antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6\%) of the cases, 20 (3.4\%) in cefuroxime patients and 17 (3.8\%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.},
  language  = {en}
}
@phdthesis{Bernsen2021,
  author    = {Bernsen, Dominik},
  title     = {Die Auswirkungen einer Umstellung der perioperativen Antibiotikaprophylaxe in der Herzchirurgie: Ein Vergleich von Cephalosporinen der ersten und zweiten Generation},
  doi       = {10.25972/OPUS-24311},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-243119},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Zum 01.06.2017 wurde in der Universit{\"a}tsklinik W{\"u}rzburg im Rahmen des 'Antimicrobial Stewardship' in der Herzchirurgie die perioperative Antibiotikaprophylaxe von Cefuroxim auf Cefazolin umgestellt. Diese Studie untersucht insgesamt 1029 Patienten vor und nach der Umstellung hinsichtlich ihrer Raten an Wundinfektionen, nosokomialen Infektionen und Risikofaktoren zur Entwicklung einer postoperativen Wundinfektion. Die Ergebnisse zeigen, dass eine Umstellung der perioperativen Antibiotikaprophylaxe von Cefuroxim, einem Cephalosporin der zweiten Generation, auf Cefazolin, ein Cephalosporin der ersten Generation, zu keinem Anstieg der Wundinfektionen in herzchirurgischen Eingriffen f{\"u}hrt. Insgesamt lag keine signifikante {\"U}berlegenheit eines der beiden Antibiotika vor, weder in Hinblick auf die gesamten Wundinfektionen, die tiefen sternalen Wundinfektionen und die Infektionen der Beinwunde, noch bei nosokomialen Infektionen wie der Pneumonie, dem Harnwegsinfekt oder der Sepsis. Im Patientenkollektiv konnten weiterhin einige unabh{\"a}ngige pr{\"a}-, intra- und postoperative Risikofaktoren ermittelt werden, die zu einer signifikanten Steigerung der Infektionsraten f{\"u}hrten. Auch bei der differenzierten Betrachtung der Risikopatienten zeigte sich kein signifikanter Wirkungsunterschied zwischen den beiden untersuchten Antibiotika. Diese Studie weist mit 1029 Patienten ein zur existierenden Literatur vergleichsweise großes Patientenkollektiv auf. Auch die erhobenen Parameter sind umfangreich gew{\"a}hlt und boten die M{\"o}glichkeit tiefergehender Analysen. Limitiert wird die Studie jedoch durch ihr retrospektives Design mit dem Fehlen eines kontrollierten Follow-Ups. Um die Ergebnisse best{\"a}tigen und bekr{\"a}ftigen zu k{\"o}nnen, m{\"u}sste eine prospektive, randomisierte Studie hieran angeschlossen werden.},
  subject      = {Antibiotikum},
  language  = {de}
}
@article{MagyarWagnerThomasetal.2019,
  author    = {Magyar, Attila and Wagner, Martin and Thomas, Phillip and Malsch, Carolin and Schneider, Reinhard and St{\"o}rk, Stefan and Heuschmann, Peter U and Leyh, Rainer G and Oezkur, Mehmet},
  title     = {HO-1 concentrations 24 hours after cardiac surgery are associated with the incidence of acute kidney injury: a prospective cohort study},
  series = {International Journal of Nephrology and Renovascular Disease},
  volume    = {12},
  journal   = {International Journal of Nephrology and Renovascular Disease},
  doi       = {10.2147/IJNRD.S165308},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-177250},
  pages     = {9-18},
  year      = {2019},
  abstract  = {Background: Acute kidney injury (AKI) is a serious complication after cardiac surgery that is associated with increased mortality and morbidity. Heme oxygenase-1 (HO-1) is an enzyme synthesized in renal tubular cells as one of the most intense responses to oxidant stress linked with protective, anti-inflammatory properties. Yet, it is unknown if serum HO-1 induction following cardiac surgical procedure involving cardiopulmonary bypass (CPB) is associated with incidence and severity of AKI. Patients and methods: In the present study, we used data from a prospective cohort study of 150 adult cardiac surgical patients. HO-1 measurements were performed before, immediately after and 24 hours post-CPB. In univariate and multivariate analyses, the association between HO-1 and AKI was investigated. Results: AKI with an incidence of 23.3\% (35 patients) was not associated with an early elevation of HO-1 after CPB in all patients (P=0.88), whereas patients suffering from AKI developed a second burst of HO-1 24 hours after CBP. In patients without AKI, the HO-1 concentrations dropped to baseline values (P=0.031). Furthermore, early HO-1 induction was associated with CPB time (P=0.046), while the ones 24 hours later lost this association (P=0.219). Conclusion: The association of the second HO-1 burst 24 hours after CBP might help to distinguish between the causality of AKI in patients undergoing CBP, thus helping to adapt patient stratification and management.},
  language  = {en}
}
@article{OezkurMagyarThomasetal.2018,
  author    = {Oezkur, Mehmet and Magyar, Atilla and Thomas, Phillip and Reif, Andreas and St{\"o}rk, Stefan and Heuschmann, Peter U. and Leyh, Rainer G. and Wagner, Martin},
  title     = {The COMT-polymorphism is not associated with the incidence of acute kidney injury after cardiac surgery - a prospective cohort study},
  series = {BMC Nephrology},
  volume    = {19},
  journal   = {BMC Nephrology},
  number    = {34},
  doi       = {10.1186/s12882-018-0820-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-175529},
  year      = {2018},
  abstract  = {Background: The Catechol-O-methyltransferase (COMT) represents the key enzyme in catecholamine degradation. Recent studies suggest that the COMT rs4680 polymorphism is associated with the response to endogenous and exogenous catecholamines. There are, however, conflicting data regarding the COMT Met/Met phenotype being associated with an increased risk of acute kidney injury (AKI) after cardiac surgery. The aim of the current study is to prospectively investigate the impact of the COMT rs4680 polymorphism on the incidence of AKI in patients undergoing cardiac surgery. Methods: In this prospective single center cohort study consecutive patients hospitalized for elective cardiac surgery including cardiopulmonary-bypass (CPB) were screened for participation. Demographic clinical data, blood, urine and tissue samples were collected at predefined time points throughout the clinical stay. AKI was defined according to recent recommendations of the Kidney Disease Improving Global Outcome (KDIGO) group. Genetic analysis was performed after patient enrolment was completed. Results: Between April and December 2014, 150 patients were recruited. The COMT genotypes were distributed as follows: Val/Met 48.7\%, Met/Met 29.3\%, Val/Val 21.3\%. No significant differences were found for demography, comorbidities, or operative strategy according to the underlying COMT genotype. AKI occurred in 35 patients (23.5\%) of the total cohort, and no differences were evident between the COMT genotypes (20.5\% Met/Met, 24.7\% Val/Met, 25.0\% Val/Val, p = 0.66). There were also no differences in the post-operative period, including ICU or in-hospital stay. Conclusions: We did not find statistically significant variations in the risk for postoperative AKI, length of ICU or in-hospital stay according to the underlying COMT genotype.},
  language  = {en}
}
@article{HamoudaOezkurSinhaetal.2015,
  author    = {Hamouda, Khaled and Oezkur, Mehmet and Sinha, Bhanu and Hain, Johannes and Menkel, Hannah and Leistner, Marcus and Leyh, Rainer and Schimmer, Christoph},
  title     = {Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: an observational study},
  series = {Journal of Cardiothoracic Surgery},
  volume    = {10},
  journal   = {Journal of Cardiothoracic Surgery},
  number    = {25},
  doi       = {10.1186/s13019-015-0225-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124977},
  year      = {2015},
  abstract  = {Background All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac surgery patients were assigned to one of two groups receiving PAB with a second-generation cephalosporin for either 56 h (group I) or 32 h (group II). Patients' characteristics, intraoperative data, and the in-hospital follow-up were analysed. Primary endpoint was the incidence of surgical site infection (deep and superficial sternal wound-, and vein harvesting site infection; DSWI/SSWI/VHSI). Secondary endpoints were the incidence of respiratory-, and urinary tract infection, as well as the mortality rate. Results 615/1096 patients (56,1\%) were enrolled (group I: n = 283 versus group II: n = 332). There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. No statistically significant differences were demonstrated concerning primary and secondary endpoints. The incidence of DSWI/SSWI/VHSI were 4/283 (1,4\%), 5/283 (1,7\%), and 1/283 (0,3\%) in group I versus 6/332 (1,8\%), 9/332 (2,7\%), and 3/332 (0,9\%) in group II (p = 0,76/0,59/0,63). In univariate analyses female gender, age, peripheral arterial obstructive disease, operating-time, ICU-duration, transfusion, and respiratory insufficiency were determinants for nosocomial infections (all ≤ 0,05). Subgroup analyses of these high-risk patients did not show any differences between the two regimes (all ≥ 0,05). Conclusions Reducing the duration of PAB from 56 h to 32 h in adult cardiac surgery patients was not associated with an increase of nosocomial infection rate, but contributes to reduce antibiotic resistance and health care costs.},
  language  = {en}
}
@phdthesis{Guggenmos2014,
  author    = {Guggenmos, Kristina},
  title     = {Neurologische Komplikationen bei kardiochirurgischen Patienten in Bezug auf den pr{\"a}operativen Carotisdoppler Befund: eine retrospektive Analyse},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-104155},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2014},
  abstract  = {Diese Studie analysiert ein Patientenkollektiv, das sich einem herzchirurgischen Eingriff unterzogen und gleichzeitig postoperativ ein neurologisches Defizit entwickelt hat, in Bezug auf pr{\"a}operative Carotis-/Vertebralisstenosen und kardiovaskul{\"a}re Risikofaktoren.},
  subject      = {Herzchirurgie},
  language  = {de}
}
@phdthesis{Mai2005,
  author    = {Mai, Matthias},
  title     = {Risikostratifizierung in der Herzchirurgie - Betrachtung von 6 Risiko-Scores im Hinblick auf ihre Anwendbarkeit und prognostische Wertigkeit},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-13764},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2005},
  abstract  = {In der vorliegenden Arbeit wurden 6 der bekanntesten Risiko-Scores zur Absch{\"a}tzung der perioperativen Mortalit{\"a}t bei herzchirurgischen Eingriffen miteinander verglichen (Parsonnet-Score, Cleveland Clinic-Score, Ontario Province Risk-Score, French-Score, Pons-Score und Euro-Score). Hierzu wurden die Daten von 135 Patienten, die sich von Mai bis einschließlich September 2002 einer Herzoperation (Bypass-, Herzklappen-, oder Kombinations-Operation) an der Klinik f{\"u}r Herz- und Thorax-Chirurgie der Universit{\"a}t W{\"u}rzburg unterzogen, nachuntersucht. Da nur 3/6 der Risiko-Scores eine Aussage bez{\"u}glich der postoperativen Morbidit{\"a}t treffen, wurden die, die Morbidit{\"a}t betreffenden Daten keiner statistischen Analyse zugef{\"u}hrt. 3/135 Patienten verstarben perioperativ (2,2\%). 74/135 Patienten entwickelten postoperativ Komplikationen (54,8\%). Die Analyse der Daten zeigte f{\"u}r keinen der Risiko-Scores statistische Signifikanz (p \&\#8804; 0,05). Der Euro-Score war der einzige Risiko-Score, der alle verstorbenen Patienten in die Gruppe mit dem h{\"o}chsten Risiko eingeteilt hatte. Aufgrund seiner vielen Parameter und wenigen Punkte pro Parameter ist der Euro-Score f{\"u}r zuf{\"a}llige Ereignisse und Fehleinteilungen weniger anf{\"a}llig als andere Risiko-Scores. Die Mortalit{\"a}t als Endpunkt ist f{\"u}r einen Risiko-Score besser geeignet als die Morbidit{\"a}t, da kein Raum f{\"u}r subjektive Auslegung und Fehleinsch{\"a}tzung besteht. Aufgrund der Schwierigkeit gemeinsame pr{\"a}diktive Parameter f{\"u}r Mortalit{\"a}t und Morbidit{\"a}t zu finden sollten getrennte Score-Systeme zur Anwendung kommen. Jeder Risiko-Score sollte von Zeit zu Zeit {\"u}berarbeitet und dem medizinischen Fortschritt angepasst werden, bei der Auswahl der Parameter ist auf ausreichende Objektivit{\"a}t und exakte Definition zu achten.},
  language  = {de}
}