Journal
DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
Volume 84, Issue 3, Pages 261-265Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.diagmicrobio.2015.11.011
Keywords
Post-operative mediastinitis; Sternal osteomyelitis; Deep sternal wound infection; Sternotomy; Negative pressure wound therapy
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Funding
- Healthcare Manpower Development Plan, Ministry of Health, Singapore
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Deep sternal wound infection (DSWI) is a feared complication following cardiac surgery. This study describes clinical, microbiological, and treatment outcomes of DSWI and determines risk factors for complications. Of 55 patients with DSWI, 66% were male and mean age was 68.2 years. Initial sternotomy was for coronary artery bypass graft in 49% of patients. Sternal debridement at mean 25.4 +/- 18.3 days showed monomicrobial (94%), mainly Gram-positive infection. Secondary sternal wound infection (SSWI) occurred in 31% of patients, was mostly polymicrobial (71%), and was predominantly due to Gram-negative bacilli. Risk factors for SSWI were at least 1 revision surgery (odds ratio [OR] 4.8 [95% confidence interval {CI} 1.0-22.4], P = 0.047), sternal closure by muscle flap (OR 4.6[1.3-16.8], P = 0.02), delayed sternal closure (mean 27 versus 14 days, P = 0.03), and use of vacuum-assisted closure device (100% versus 58%, P = 0.008). Hospital stay was significantly longer in patients with SSWI (69 days versus 48 days, P = 0.04). (C) 2016 Elsevier Inc. All rights reserved.
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