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Serious infectious complications of midsternotomy: a review of bacteriology and antimicrobial therapy
Y Siegman-Igra1, R Shafir, J Weiss
1Infectious Disease Unit, Rokach Hospital, Tel-Aviv, Israel.
Abstract:
49 patients with severe infectious complications of midsternotomy incision were treated at our referral center over a 3-year period. 43 species of microorganisms were identified in 38 patients, the most common being Pseudomonas aeruginosa (37%) and Staphylococcus aureus (30%). Most of the patients underwent aggressive debridement and chest wall reconstruction by muscle transposition in combination with antimicrobial therapy. Antimicrobial therapy was given perioperatively according to the in vitro susceptibility of the organisms. Treatment was continued beyond this period for 2-3 weeks in patients with extensive deep seated infection or in those with positive cultures from intraoperative specimens. Some patients needed a longer course of up to 6-8 weeks antimicrobial therapy because of insufficient response to the shorter course. In all, 45/49 patients had complete wound healing. 28 recovered within 2-5 weeks and 16 required a more protracted course with additional surgery in 8; 1 wound did not heal after 20 months and 4 patients died from non-infectious complications. Due to the lack of specific guidelines in the literature as to the proper choice and length of administration of antimicrobial therapy for midsternotomy wound infection, and in view of these favorable results, we recommend our protocol in the treatment of midsternotomy wound infection (in combination with appropriate surgery).
Insights
This study evaluated 49 patients with midsternotomy incision infections, finding Pseudomonas aeruginosa and Staphylococcus aureus most common. A recommended treatment protocol combining surgery and tailored antimicrobial therapy achieved high healing rates.
Area of Science:
- Infectious Diseases
- Surgical Site Infections
- Antimicrobial Therapy
Background:
- Midsternotomy incision infections are severe complications following cardiac surgery.
- Effective treatment protocols are lacking, necessitating further research.
Purpose of the Study:
- To evaluate the efficacy of a combined surgical and antimicrobial therapy protocol for treating severe midsternotomy incision infections.
- To identify common causative microorganisms and their susceptibility patterns.
Main Methods:
- Retrospective analysis of 49 patients treated over 3 years.
- Aggressive debridement and chest wall reconstruction with muscle transposition.
- Perioperative antimicrobial therapy guided by in vitro susceptibility, with extended courses for deep infections.
Main Results:
- 43 microbial species identified; Pseudomonas aeruginosa (37%) and Staphylococcus aureus (30%) were most prevalent.
- 45 of 49 patients achieved complete wound healing.
- Most patients recovered within 2-5 weeks; 8 required additional surgery.
Conclusions:
- The recommended protocol, combining surgical intervention with tailored antimicrobial therapy, demonstrates favorable outcomes for midsternotomy wound infections.
- This approach addresses the lack of specific guidelines and can lead to successful wound healing.