Candida Sternal Wound Infections After Open-Heart Surgery: A retrospective Observational Study

Objective Sternal wound infection (SWI) is a devastating complication following cardiac surgery. Although most SWI are bacterial and well described, Candida SWI remains poorly characterized. This study aimed to examine the clinical characteristics, management, and outcomes of Candida SWI. Methods We retrospectively reviewed the data of patients with Candida SWI following cardiac surgery at Baylor St. Luke's Medical Center between 2013 and 2024. Results Of the 11,108 cardiac surgeries, 55 Candida SWI were identified: superficial (10.9%), deep (21.8%), sternal osteomyelitis (40.0%), and mediastinitis (27.3%). Most occurred within 90 days postoperatively (70.9%). Candida albicans was most common (69.1%), followed by C. parapsilosis (12.7%), C. glabrata (9.1%), and C.tropicalis (7.3%). Surgical intervention was performed in 87.3% of the patients, and 60.0% received antifungal therapy for >6 weeks. The ninety-day mortality was 20.0%. In-hospital mortality was significantly associated with postoperative mechanical ventilation >48 hours [100% (in-hospital death group) vs. 63.9% (survivor group), OR: 17.38, 95% CI, 0.95-316.99; P =.008] and a lack of surgical debridement [26.4% (in-hospital death group) vs. 6.8% (survivor group), OR: 0.14, 95% CI, 0.02-0.79, P =.023]. However, it was not associated with mediastinitis [54.5% (in-hospital death group) vs. 20.5% (survivor group), OR: 4.41, 95% CI, 1.15-16.90; P =.052]. Mediastinitis was associated with a longer cardiopulmonary bypass time [213 min (mediastinitis group) vs. 142.5 min (non-mediastinitis group), P =.005] and extended postoperative hospital stays [55 days (mediastinitis group) vs. 36 days (non-mediastinitis group), P =.027]. Conclusions Candida SWI presented with variable extents and onsets. Despite aggressive surgical management and prolonged antifungal therapy, the prognosis remains challenging.