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Sternal and costochondral infections with gentamicin and methicillin resistant Staphylococcus aureus following
Abstract:
Six patients in a thoracic unit developed sternal osteomyelitis and costochondritis following median sternotomy. Five of the patients were operated on in another hospital. Gentamicin and methicillin resistant Staphylococcus aureus was isolated in pure culture in each case. The S. aureus isolate from 2 patients was of the same phage type suggesting cross-infection. Antibiotic prophylaxis administered in the perioperative period was ineffective. One patient, treated with amikacin (to which all of the strains were sensitive in vitro) and cefuroxime, died from overwhelming infection in spite of débridement and resuturing of the wound. The remaining 5 patients were cured with vancomycin therapy usually coupled with surgical intervention.
Insights
Sternal osteomyelitis and costochondritis caused by methicillin-resistant Staphylococcus aureus (MRSA) occurred in six patients post-median sternotomy. Vancomycin therapy, often with surgery, successfully treated five patients, while one succumbed to infection.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Osteomyelitis
Background:
- Median sternotomy is a common surgical procedure.
- Post-sternotomy infections, including sternal osteomyelitis and costochondritis, pose significant risks.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a challenging pathogen in healthcare settings.
Purpose of the Study:
- To investigate the incidence and management of sternal osteomyelitis and costochondritis following median sternotomy.
- To identify the causative pathogen and assess treatment outcomes.
- To evaluate the effectiveness of antibiotic prophylaxis and therapy.
Main Methods:
- Retrospective case series of six patients in a thoracic unit.
- Identification of causative bacteria through microbiological cultures.
- Phage typing of Staphylococcus aureus isolates to assess potential cross-infection.
- Review of antibiotic regimens and surgical interventions.
Main Results:
- Six patients developed sternal osteomyelitis and costochondritis post-median sternotomy.
- Gentamicin and methicillin-resistant Staphylococcus aureus (MRSA) was isolated in all cases.
- Two isolates shared the same phage type, suggesting cross-infection.
- Perioperative antibiotic prophylaxis was ineffective.
- One patient died despite amikacin and cefuroxime treatment.
- Five patients were cured with vancomycin, often combined with surgical intervention.
Conclusions:
- MRSA is a significant cause of post-sternotomy sternal osteomyelitis and costochondritis.
- Standard antibiotic prophylaxis may be insufficient.
- Vancomycin therapy, coupled with surgical intervention, demonstrates efficacy in treating these infections.