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Spore siege: diagnostic and therapeutic challenges in fungal sternal osteomyelitis-a case series

Syeda Sakina Mehdi1, Hina Inam2, Syed Faisal Mehmood3

  • 1Medical College, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan. syeda.mehdi@scholar.aku.edu.

BMC Infectious Diseases
|July 13, 2026
PubMed
Abstract

Insights

Deep sternal wound infections (DSWI) are rare but serious complications after cardiac surgery. This study found Candida species were the main fungal cause in their patients, unlike global trends, highlighting the need for tailored treatment.

Area of Science:

  • Infectious Diseases
  • Cardiothoracic Surgery
  • Mycology

Background:

  • Deep sternal wound infections (DSWI) are rare, potentially fatal complications following cardiac surgery.
  • Fungal involvement in DSWI is uncommon but associated with high morbidity and mortality.

Purpose of the Study:

  • To describe the clinical spectrum, management, and outcomes of fungal DSWI after cardiac surgery.
  • To emphasize pathogen distribution, diagnostic challenges, and therapeutic approaches for this rare entity.
  • To inform optimized, multidisciplinary care strategies for fungal DSWI.

Main Methods:

  • Retrospective review of seven patients with culture-proven fungal DSWI.
  • Analysis of clinical features, imaging, microbiology, treatment, and patient outcomes.
  • Study conducted at a tertiary care center between 2019 and 2024.

Main Results:

  • Candida species (4 cases) predominated over Aspergillus species (3 cases), differing from global trends.
  • All patients received surgical debridement, systemic antifungal therapy, and adjunctive wound care.
  • Five patients recovered; two patients with comorbidities died.

Conclusions:

  • Fungal sternal osteomyelitis is a severe DSWI requiring early recognition and multimodal management.
  • Candida predominance in this cohort necessitates considering both yeast and mold infections.
  • Individualized treatment, timely surgery, and judicious antifungal use are crucial for improving outcomes.
Keywords:
Antifungal therapyAspergillusCandidaDeep sternal wound infectionFungal sternal osteomyelitisMediastinitisPost–cardiac surgery infectionSurgical debridementVacuum-assisted closure

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