Review on risk factors, classification, and treatment of sternal wound infection

Song, Yaoyao; Chu, Wanli; Sun, Jiachen; Liu, Xinzhu; Zhu, Hongwei; Yu, Hongli; Shen, Chuanan

doi:10.1186/s13019-023-02228-y

Cited by 20 publications

(11 citation statements)

References 64 publications

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“…After successful surgery and despite a favorable postoperative course, the patient experienced complications that required readmission to the hospital. Sternal wound infections are known to be severe complications that can occur after chest wall surgeries and carry a substantial risk of morbidity and mortality [ 12 ]. To address this complication, the patient was treated effectively with antibiotics, immediate wound revision, and partial omentoplasty.…”

Section: Discussionmentioning

confidence: 99%

Chondrosarcoma of the Sternum: Surgical Challenges, Chest Wall Reconstruction, and Postoperative Management

Trepić,

Nemet,

Ergelašev

2024

Cureus

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Although rare, primary chondrosarcoma is the most frequent malignant tumor of the sternum. It commonly manifests as a painful, expanding mass arising from the costochondrosternal junction. Since it is resistant to radiotherapy and chemotherapy, surgical resection with reconstruction is the preferred treatment. A 50-year-old male presented with swelling over the left fourth sternocostal joint, gradually increasing in size. Imaging and clinical assessment suggested an infiltrative neoplasm, and surgical resection was indicated. The patient underwent a partial sternectomy, including a resection of the xiphoid process and costal cartilages two to seven and a partial resection of the manubrium. Postoperative pathohistological analysis specified the change as a low-grade chondrosarcoma in the pT1 stage. Chest wall reconstruction involved three pectus bars fixated around the ribs and the placement of a synthetic polypropylene mesh. The patient required postoperative rehospitalization due to partial skin layer wound dehiscence, serous drainage, and fever. Empirical antibiotic therapy was initiated, and the patient underwent a median superior laparotomy with partial omentoplasty of the sternal region, preserving the mesh and pectus bars. A culture analysis revealed methicillin-resistant Staphylococcus epidermidis , and postoperative antibiotic therapy was adapted to the antibiogram. Subsequently, all parameters of inflammation decreased, and wound healing followed. A one-year follow-up CT scan showed no disease recurrence. This case highlights the intricate surgical management that contributed to the successful treatment of sternal chondrosarcoma. Sternal wound infection, a severe postoperative complication with a high mortality rate, requires prompt identification, precise revision with culture-directed antibiotics, and effort to preserve the prosthetic material.

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Section: Discussionmentioning

confidence: 99%

Chondrosarcoma of the Sternum: Surgical Challenges, Chest Wall Reconstruction, and Postoperative Management

Trepić,

Nemet,

Ergelašev

2024

Cureus

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“…Further, the review identifies the importance of personalizing SSI prevention strategies based on patientspecific factors, such as diabetes type and surgical procedure [13,14]. This approach is particularly crucial for insulin-dependent diabetics undergoing complex surgeries, suggesting a need for stricter protocols and monitoring.…”

Section: Discussionmentioning

confidence: 99%

Effective Surgical Site Infection Prevention Strategies for Diabetic Patients Undergoing Surgery: A Systematic Review

Abdallah,

Hammoud,

Al Balushi

et al. 2024

Cureus

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Surgical site infections (SSIs) pose a significant clinical challenge, with heightened risks and severe consequences for diabetic patients undergoing surgical procedures. This systematic review aims to synthesize the current evidence on effective prevention strategies for mitigating SSI risk in this vulnerable population.From inception to March 2024, we comprehensively searched multiple electronic databases (PubMed, Medline, Embase, Cochrane Library, CINAHL) to identify relevant studies evaluating SSI prevention strategies in diabetic surgical patients. Our search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, utilizing a combination of keywords and Medical Subject Headings (MeSH) terms related to diabetes, surgical site infections, prevention strategies, and surgical procedures. Inclusion criteria focused on peer-reviewed clinical trials, randomized controlled trials, and meta-analyses published in English.The search yielded three studies meeting the eligibility criteria, subject to data extraction and qualitative synthesis. Key findings highlighted the efficacy of interventions such as optimized perioperative glycemic control, timely prophylactic antibiotic administration, and meticulous preoperative skin antisepsis in reducing SSI rates among diabetic surgical patients. The potential for personalized prevention approaches based on individual patient factors, such as diabetes type and surgical complexity, was explored. This systematic review underscores the importance of a multifaceted, evidence-based approach to SSI prevention in diabetic surgical patients, integrating strategies like glycemic control, antibiotic prophylaxis, and preoperative skin antisepsis. Furthermore, our findings suggest the potential benefits of personalized care pathways tailored to individual patient characteristics. Implementing these interventions requires interdisciplinary collaboration, adaptation to diverse healthcare settings, and patient engagement through culturally sensitive education initiatives. This comprehensive analysis informs clinical practice, fosters patient safety, and contributes to the global efforts to enhance surgical outcomes for this high-risk population.

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“…Increased prevalence of gram-positive cocci, particularly methicillin-resistant Staphylococcus aureus , has been noted during the initial phase of DSWI. [11] Consequently, anti-infection approaches frequently involve the administration of glycopeptide antibiotics or linezolid. Healthcare professionals frequently use carbapenems, third-generation cephalosporins, or enzyme-enhanced β-lactams as part of their anti-infection protocols in cases with extended duration of DSWI indicative of increased negative bacilli and fungal infections.…”

Section: Methodsmentioning

confidence: 99%

Clinical analysis of patients with deep sternal wound infection-induced sepsis: a retrospective cohort study

Song,

Cui,

et al. 2024

Emerg Crit Care Med

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Background This study aimed to summarize the clinical characteristics of patients with deep sternal wound infection-induced sepsis after median sternotomy and improve the treatment outcomes of infection-related sepsis. Methods A retrospective cohort study was conducted on 21 patients with deep sternal wound infection-induced sepsis after median sternotomy who were admitted to the Department of Critical Care. The clinical manifestations, laboratory test results, infection control, and organ and nutritional support of the patients were summarized, and the follow-up data were obtained. Results The primary symptoms of deep sternal wound infection-induced sepsis included dyspnea, high fever, chills, and altered state of consciousness. Laboratory test results revealed increased inflammatory markers and decreased oxygenation index. Renal and liver function injury were observed in 8 and 4 patients, respectively; 18 and 12 patients demonstrated elevated D-dimer and N-terminal Pro B type natriuretic peptide levels, respectively. Of the 8 patients whose wound secretions tested positive for bacteria, Acinetobacter baumannii and Staphylococcus aureus infections were present in 6 and 2 patients, respectively. One of the 6 patients whose blood cultures tested positive for bacteria demonstrated Candida albicans infection. Fifteen patients received ventilator-assisted ventilation and 2 patients received renal replacement therapy. Of all the 21 patients, 17 were cured, 2 died, and 2 were discharged. Conclusion Postmedian sternotomy sepsis attributed to a deep sternal wound infection usually results from a preexisting condition. The most prominent clinical manifestation is dyspnea, which is sometimes accompanied by the impairment of organ function. Infection prevention, proper nutrition support, and maintenance of healthy organ function are the cornerstones for successful treatment outcomes.

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Review on risk factors, classification, and treatment of sternal wound infection

Cited by 20 publications

References 64 publications

Chondrosarcoma of the Sternum: Surgical Challenges, Chest Wall Reconstruction, and Postoperative Management

Chondrosarcoma of the Sternum: Surgical Challenges, Chest Wall Reconstruction, and Postoperative Management

Effective Surgical Site Infection Prevention Strategies for Diabetic Patients Undergoing Surgery: A Systematic Review

Clinical analysis of patients with deep sternal wound infection-induced sepsis: a retrospective cohort study

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