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Deep Sternal Wound Infection After Open-heart Cardiac Surgery and Vacuum-Assisted Closure Therapy: a Single-center
Bedrudin Banjanovic1, Ilirijana Haxhibeqiri Karabdic1, Slavenka Straus1
1Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Bosnia, and Herzegovina.
Insights
Deep sternal wound infection (DSWI) following cardiac surgery remains a significant complication. Identifying at-risk patients is crucial for reducing DSWI incidence and improving outcomes after median sternotomy procedures.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Wound Management
Background:
- Deep sternal wound infection (DSWI) is a significant complication after cardiac surgery via median sternotomy, despite preventative advances.
- DSWI leads to prolonged hospital stays and increased healthcare costs.
Purpose of the Study:
- To determine the incidence and risk factors of DSWI in patients undergoing cardiac surgery with median sternotomy.
- To identify common microbiological findings and antibiotic therapies for DSWI.
- To evaluate the role of Vacuum-Assisted Closure (VAC) therapy in DSWI treatment.
Main Methods:
- Retrospective observational study of 15 patients with DSWI post-cardiac surgery.
- Data collected from November 2015 to November 2020.
- Inclusion criteria: DSWI after median sternotomy, complete microbiological data; exclusion criteria: incomplete clinical data.
Main Results:
- DSWI occurred in 1% of sternotomy patients; 60% were male, average age 66.
- Coronary artery bypass grafting (CABG) was the most common surgery (73.3%).
- Enterococcus faecalis (27%) was the predominant pathogen; mortality rate was 33.3%.
Conclusions:
- Early identification of patients at risk for DSWI is essential for reducing its incidence.
- Understanding microbiological patterns aids in appropriate antibiotic selection.
- Further research into effective DSWI treatment strategies, including VAC therapy, is warranted.
Background:
Despite many advances in the prevention, of sternal wound infection, especially deep ones, cardiac surgery with median sternotomy, still presents a significant postoperative complication. Numerous operative and non-operative procedures should be used in treatment, there is a prolonged hospital stay and increased hospital costs treating this postoperative complication.
Objective:
The present study was conducted aiming to determine the incidences, and risk factors, identify microbiology findings, and antibiotic therapy among patients with DSWI who underwent cardiac surgery with median sternotomy at our Clinic and VAC treatment.
Methods:
This retrospective observational study was conducted in Clinic for Cardiovascular Surgery at University Clinical Center Sarajevo from November 2015 to November 2020. The data were obtained from 15 patients with deep sternal wound infection (DSWI) following open-heart surgery. The inclusion criteria were DSWI after cardiac operation via median sternotomy, and complete results of microbiological findings obtained by sternal swab. The exclusion criteria were patients with incomplete clinical data.
Results:
We found that 9 (60%) patients were males and 6 (40%) were females. Coronary artery bypass grafting (CABG) operation had 11 (73,3%) patients, CABG with aortic valve replacement 2 (13,3%), valve replacement surgery operations (13,3%). The average age was 66 years. All patients were elective surgery patients. STS score in the Non-VAC group was 22.6, in the VAC group 16.6, and the average was 14.9. The number of patients with DSWI represents 1% of all sternotomy patients in the observed period. Two risk factors for DSWI had 37% of patients, 25% of them were diabetic, and 3 (9%) were overweight. Enterococcus faecalis was isolated predominantly in 6 (27%) patients, followed by Klebsiella pneumonia 3 (13%), Proteus mirabilis 2 (9%), and Serratia Maecenas 2 (9%). The mortality rate was 33.3% (5 of 15).
Conclusion:
The results of our study present our experience with DSWI treatment after open-heart surgery. What comes from our experience so far, is that is very important to determine patients who are at risk of developing DSWI after cardiac surgeries to lower its incidence.
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