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Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention
The Annals of Thoracic Surgery
|May 11, 1976
Summary
Pseudomonas cepacia bacteremia, not just wound contamination, can cause sternal osteomyelitis and mediastinitis after heart surgery. Preventing these infections requires vigilance in sterilization and monitoring practices.
Area of Science:
- Infectious Diseases
- Cardiovascular Surgery
- Medical Microbiology
Background:
- Postoperative sternal osteomyelitis and mediastinitis are serious complications following cardiac surgery.
- Traditionally, local wound contamination is considered the primary cause of these infections.
Observation:
- A patient developed sternal osteomyelitis and mediastinitis caused by Pseudomonas cepacia two weeks after coronary artery bypass surgery.
- This infection was preceded by Pseudomonas cepacia bacteremia, likely originating from a contaminated pressure transducer.
Findings:
- This case highlights bacteremia as a significant cause of gram-negative sternal infections post-cardiac surgery.
- It challenges the prevailing view that local wound contamination is the sole or primary etiology.
Implications:
- Preventing severe postoperative chest infections necessitates careful preoperative patient evaluation and antibiotic selection.
- Thorough periodic review of equipment sterilization and intravascular monitoring practices is crucial for patient safety.