[REVIEW OF COMMON PATHOGENS IN THE BONE AND BLOOD CULTURES AND ANTIBIOTIC TREATMENT IN PATIENTS WITH STERNAL...

This study concentrates on microbiological data collection of deep sternal wounds to delineate early and correct antibiotic therapy.

Deep sternal wound infection, mediastinitis and sternal osteomyelitis are devastating and life-threatening complications of median-sternotomy incisions after cardiac surgical procedures. The incidence of surgical wound infection in sternotomies should be similar to that in any clean surgical procedure (i.e. approximately 2%). Nonetheless, the infection rates are higher among heart disease patients, due to the fact that these patients are burdened with a high number of risk factors in comparison with the general population.

In line with other publications, the most commonly cultured organism from deep sternal wound and blood cultures was found to be Staphylococcus. In comparison, the most commonly cultured Gram-negative organisms were Pseudomonas and all gram-negative organisms combined together represented approximately 50% of all cultures. Three dominant organisms were isolated from wound and blood cultures: Staphylococcus, Pseudomonas and Acinetobacter. We found that 40% of blood cultures were identical to prior wound cultures, in comparison to 30% of bone cultures. Furthermore, 20% of the organisms isolated from the wound and 13% of the organisms isolated from the bone later on cross over to involve the blood.

Empiric antibiotic regimen should be broad spectrum and cover both gram-positive as well as gramnegative organisms. We demonstrate that antibiotic regimen during sepsis may rely partially on preliminary wound cultures. Furthermore, antibiotic treatment for a relatively short period of two weeks is adequate, alongside thorough surgical revision with debridement of all foreign bodies, and reconstruction with vascularized soft tissue flap (pectoral major).