A late sternal wound infection caused by hematogenous spread of bacteria

Area of Science:

• Infectious Diseases
• Cardiovascular Surgery
• Orthopedic Surgery

Background:

• Sternotomy wound infections are a serious complication following coronary artery bypass grafting (CABG).
• Group B beta-hemolytic Streptococcus (GBS) is a less common pathogen in adult sternotomy infections compared to other bacteria.
• Hematogenous spread is a recognized route for prosthetic joint infections but is rare for sternotomy sites.

Observation:

• A 56-year-old male developed a sternotomy wound infection six months after CABG.
• The causative agent identified was Group B beta-hemolytic Streptococcus.
• Concurrently, GBS was isolated from a diabetic foot ulcer and a total knee prosthesis in the same patient.

Findings:

• This case highlights an extremely rare instance of sternotomy wound infection caused by Group B Streptococcus.
• The findings suggest a hematogenous seeding of the sternum from a distant infected site (diabetic foot ulcer).
• The simultaneous presence of GBS in a prosthetic joint further supports the concept of systemic bacterial dissemination.

Implications:

• Clinicians should consider rare pathogens like GBS in delayed sternotomy wound infections, especially in patients with comorbidities and distant infections.
• The possibility of hematogenous spread to the sternum from extragenital sites warrants consideration in complex cases.
• This case underscores the importance of a thorough microbiological workup to identify the source of infection and guide appropriate treatment, particularly in patients with multiple prosthetic devices or chronic infections.