Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Abstract

Poststernotomy mediastinitis (PSM) is one of the most serious complications of cardiac surgery, and its associated morbidity and mortality demand early recognition for emergency therapy. In this study, we investigated the usefulness of epicardial pacing wire (EPW) cultures for the prediction of PSM. Among 2,200 patients who underwent a cardiac surgical procedure at our hospital between 1 January 1999 and 31 December 2001, 82 (3.7%) had PSM; Staphylococcus aureus was the organism (45.1%) most frequently isolated at the time of surgical debridement. EPWs from 1,607 (73.0%) patients, 73 (4.5%) of whom developed PSM, were cultured. EPW cultures from 466 (29.0%) were positive, most often (74.9%) for coagulase-negative Staphylococci. EPW cultures were truly positive in 26 cases, truly negative in 1,106 cases, falsely positive in 428 cases, and falsely negative in 47 cases (with sterile cultures in 35 cases and a culture positive for an organism different from that isolated at the time of debridement in 12 cases). EPW culture had a positive predictive value of only 5.7% and a high negative predictive value (95.9%) for the diagnosis of PSM, with an accuracy of 70.4%. However, the likelihood ratio of positive (1.27) and negative (0.89) tests indicated only small changes in pretest-to-posttest probability. Therefore, a strategy of routine culture of EPWs to predict PSM seems questionable.Poststernotomy mediastinitis (PSM) is a life-threatening complication that occurs in about 1 to 5% of cardiac surgery procedures. PSM is associated with major patient morbidity, mortality, and cost (11). Successful management of this infection requires early diagnosis and aggressive treatment (5). In fact, the prognosis for patients with PSM appears to be related to the length of time required for the institution of treatment (4). The diagnosis of PSM is sometimes straightforward, and it is established by physical examination of the wound and by conventional laboratory studies. However, diagnosis in the early stages where treatment is the most effective is often difficult, and multiple diagnostic procedures are sometimes necessary to ascertain the infectious process.Epicardial pacing wires (EPWs) are fixed in the pericardium at the end of cardiac surgery procedures to treat postoperative bradyarrythmias. Some authors have suggested that EPW cultures might be helpful in the early diagnosis of PSM (2,8,12). However, these studies included only a small number of patients with PSM (35 patients in all). The present study was undertaken to evaluate our strategy of routine EPW culture and its contribution to identification of PSM at an early stage. MATERIALS AND METHODS Study population.All patients who underwent a cardiac surgical procedure via median sternotomy between 1 January 1999 and 31 December 2001 at Henri Mondor University Hospital (Créteil, France) were studied. Body hair was removed the day before operation with a clipper. Patients showered the night and morning before surgery with a povidone-iodine solution (or chlorhexidine in case...

Risk Factors for Mediastinitis Following Median Sternotomy in Children

“…26 Although the presence and longer duration of an invasive catheter has been previously found to be associated with development of a SSI, 5 the presence of an intracardiac catheter in the atria for more than 3 days did not reach statistical significance in our study. Temporary epicardial pacing wires are routinely placed in patients undergoing cardiac surgery to manage arrhythmias that complicate the postoperative period.…”

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

“…Even though the literature is scarce, some authors state that cultures of pacemaker electrodes removed between the seventh and ninth postoperative day may be useful for diagnosis, although a high percentage of false-positive results have been reported [ 101 , 102 , 103 ]. A positive culture of epicardial pacing wires does not appear to be a useful tool for early diagnosis of mediastinitis in the absence of clinical signs of infection.…”

A Case of Aspergillus fumigatus Mediastinitis After Heart Surgery in Madani Heart Center, Tabriz, Iran

“…Postsurgical mediastinitis seems to be one of the most serious postoperative complications in cardiac surgery. The reported incidence varies from 0.16% to 2.2% 1 . Classical postcardiac surgery wound infections are mostly caused by staphylococci and enterobacteriacae but is rarely due to fungal infection 2 .…”