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In Reply: Dr Scheckler described the rate of deep surgical site infection (SSI) in our study as high, comparing it with an incidence of poststernotomy mediastinitis in the United States of less than 1%. However, we reported the incidence of deep SSIs, comprising a group of SSIs greater than poststernotomy mediastinitis alone. In the United States, the comparable incidence is likely to be higher as well. An incidence of 0.4% to 5.0% for poststernotomy mediastinitis has been reported in other studies.^1-2 In our study, the overall incidence of poststernotomy mediastinitis was 1.6% (0.8% in the chlorhexidine group and 2.3% in the placebo group). Therefore, we believe that our preventive strategy can also improve the outcomes in the United States.

Scheckler may be correct that the length of hospital stay in the United States is not comparable with the Netherlands, in which the length of stay in patients with an uncomplicated . . . [Full Text of this Article]

Patrique Segers, MD
p.segers@amc.uva.nl
Department of Cardiothoracic Surgery
Academic Medical Center
University of Amsterdam

Ron G. H. Speekenbrink, PhD
Department of Cardiothoracic Surgery
Onze Lieve Vrouwe Gasthuis

Dirk T. Ubbink, PhD
Department of Clinical Epidemiology, Biostatistics, and Bioinformatics and Surgery
Academic Medical Center
University of Amsterdam

Marc L. van Ogtrop, PhD
Department of Medical Microbiology
Onze Lieve Vrouwe Gasthuis

Bas A. de Mol, PhD
Department of Cardiothoracic Surgery
Academic Medical Center
University of Amsterdam
Amsterdam, the Netherlands

RELATED LETTER

Chlorhexidine Gluconate for Prevention of Nosocomial Infection in Cardiac Surgery
William E. Scheckler
JAMA. 2007;297(10):1059-1060.
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Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate: A Randomized Controlled Trial
Patrique Segers, Ron G. H. Speekenbrink, Dirk T. Ubbink, Marc L. van Ogtrop, and Bas A. de Mol
JAMA. 2006;296(20):2460-2466.
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