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Bacteremia and sternal infection after coronary artery bypass grafting
L J Kohman1, M J Coleman, F B Parker
1State University of New York Health Science Center, Syracuse.
Insights
Sternal wound infections are common after coronary artery bypass grafting. Early detection through blood cultures and wound aspirates is crucial for managing these serious infections.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Sternal wound infection (SWI) is a significant complication following coronary artery bypass grafting (CABG).
- SWI contributes to increased patient morbidity and mortality.
- An association exists between bacteremia and SWI in CABG patients.
Purpose of the Study:
- To investigate the incidence and characteristics of sternal wound infections after CABG.
- To determine the relationship between bacteremia and sternal wound complications.
- To evaluate diagnostic approaches for early detection of SWI.
Main Methods:
- Retrospective review of 835 consecutive patients undergoing CABG.
- Analysis of infection incidence, including deep and superficial sternal wound infections.
- Correlation of bacteremia with sternal wound complications and identification of causative pathogens.
Main Results:
- The incidence of bacteremia was 3.2%, and SWI was 1.9%.
- Sternal wounds were the most common source of bacteremia (59%).
- Coagulase-negative Staphylococcus accounted for 50% of SWI; positive blood cultures often preceded local signs.
Conclusions:
- Prompt recognition of SWI is vital in postoperative CABG patients, especially those with fever.
- Multiple blood cultures are recommended for febrile CABG patients.
- Sternal wound aspirate can aid diagnosis when the infection source is unclear, enabling timely management.
Abstract:
Sternal wound infection remains a source of substantial morbidity and mortality after coronary artery bypass grafting. We noted an association between bacteremias and sternal wound complications in these patients. A review of 835 consecutive coronary bypass patients showed a 3.2% incidence of bacteremia and a 1.9% incidence of deep and superficial sternal wound infection. The sternal wound was the most common source of bacteremia, accounting for 59% of the infections. Coagulase-negative Staphylococcus was responsible for one half of the sternal wound infections. Often, a positive blood culture was the first manifestation of wound infection, occurring before local signs were manifest. We recommend multiple blood cultures in postoperative coronary bypass patients with pronounced fever. If no source of infection can be identified, sternal wound aspirate may be revealing. Appropriate early wound management can then be carried out, maximizing chances for good recovery.