Deep sternal wound infections: a severe complication after cardiac surgery

Abstract

Sternal Wound Infections (SWI) represent a dangerous complication after cardiac surgery entailing significantly longer hospital stays and worse short-term survival, especially in case of deep infections (DSWI) with the onset of osteomielitis or mediastinitis. In the literature, the real incidence of SWI 1 is estimated between 0.25% and 10%, while we can gain an insight into the prognostic impact of mediastinitis thinking about the high mortality rate between 14-47% related to this complication, that usually presents an incidence between 1-2.4%. Hereafter we describe a case in which a plastic surgical approach associated to the adoption of a VAC-therapy instill after specific antibiotic-therapy has integrated and optimized the trend of a very complex clinical circumstance. Case reportA 65-year old female was admitted at our division to undergo coronary artery bypass grafting procedure; about her medical history, the patient suffered from essential arterial hypertension, diabetes mellitus in insulin-therapy and mild obesity. Transthoracic echocardiography revealed an ejection fraction about 50% with inferior wall and posterior septum medio-basal acynesia, whereas the coronarography pointed out a three-vessel disease with involvement of the left main coronary artery. Thus, the patient underwent CABG through LIMA-LAD and SVG-OM-PDA according to the sequential technique; after surgery our conventional broad-spectrum antibiotic prophylaxis, relied on the administration of cefotaxime, was started.The post-operative course was characterized by an early psychomotor agitation, a severe glycemic decompensation and the presence of mild serosity at the third infe-

The impact of deep sternal wound infections treated by negative pressure on early, 1 year and late mortality: A longitudinal case‐control study

“…18 Since then, it was shown that this method improved blood perfusion of the wound edges' and accelerated granulation and wound healing, leading to earlier treatment of DWSI and better survival. 2,19 In the present study, DWSI was associated with a higher early inhospital (within 30 days) and 1-year mortality. Similarly, a significantly higher 30-day and 1-year mortality were reported in patients with DWSI compared with those without DWSI by Cayci et al 20 and Sears et al, 5 respectively.…”

“…After the formation of sufficient granulation and two sterile culture from the mediastinum, the sternum is closed as usual, with or without tissue flaps . Since then, it was shown that this method improved blood perfusion of the wound edges’ and accelerated granulation and wound healing, leading to earlier treatment of DWSI and better survival …”

Deep sternal wound infection following cardiac surgery: A comparison of the monolateral with the bilateral pectoralis major flaps

“…The most common pathogens detected in DSWI are Staphylococcus aureus , especially methicillin‐resistant species, followed by Gram‐negative as Pseudomonas aeruginosa , Klesbiella Pneumoniae , or Enterobacter spp. with increasing incidence and multidrug resistance …”

Association Between Post-Operative Infection and Blood Transfusion in Cardiac Surgery

“…Post-operative infection in cardiac surgery patients has been linked to patient outcome [10]. Nosocomial pneumonia, surgical site infection, mediastinitis, bacteremia, and sepsis are common infectious processes that can affect outcome [11].…”