Abstract
BackgroundSternal wound infection is a devastating complication of cardiothoracic surgery that carries high postoperative morbidity and mortality rates. We explored whether our current program of extensive bacteriological examination including repeat blood cultures may contribute to the early diagnosis of sternal wound infection.MethodsWe retrospectively analyzed 112 patients who were subjected to our bacteriological examination protocol including within 90 days after cardiothoracic surgery. Univariate and multivariate analyses were made in order to identify risk factors for sternal infection.ResultsThe median patient age was 75 years, and 65 patients were male. In 35 cases (31.2%) the blood cultures showed the presence of bacterial infection with the following frequencies: Staphylococcus aureus, 18 cases; Coagulase-negative Staphylococcus, 7 cases; other organisms, 10 cases. Eleven patients presented repeat bacteremia on at least 2 different occasions. Twenty patients (17.8%) presented sternal wound infections. There was no difference in operative mortality between the patients with and without sternal wound infection. Univariate and multivariate analyses demonstrated that bilateral mammary artery use (OR, 13.68, 95% CI, 1.09-167.36, p = 0.043), positive blood culture for Staphylococcus aureus (OR, 19.51, 95% CI, 4.46-104.33, p < 0.0001), repeat bacteremia (OR, 17.98, 95% CI, 2.51-161.77, p = 0.004) were risk factors that were associated for sternal wound infection.ConclusionRepeat blood cultures in febrile patients appear to be useful for the early detection of Staphylococcus aureus and repeat bacteremia, and these were associated with sternal wound infection. Bilateral internal mammary artery use was another risk factor of sternal wound infection in febrile patients. These factors may identify patients suitable for expeditious radiological examination and aggressive treatments.
Highlights
Sternal wound infection is a devastating complication of cardiothoracic surgery that carries high postoperative morbidity and mortality rates
Coronary bypass surgery accounted for 29.5% of the cases, whereas valve repair and/or replacement, and thoracic aorta accounted for 18 cases (16.1%) and 31 cases (27.7%), respectively
Our results clearly demonstrated that blood stream infection by Staphylococcus aureus was a strong risk factor of sternal wound infection
Summary
Sternal wound infection is a devastating complication of cardiothoracic surgery that carries high postoperative morbidity and mortality rates. We explored whether our current program of extensive bacteriological examination including repeat blood cultures may contribute to the early diagnosis of sternal wound infection. Postoperative sternal wound infection in cardiac surgery is an infrequent complication, with an incidence being 0.25-10% [1,2]. Sternal wound infection generally causes considerably high morbidity and mortality, prolonged hospital stay and increased medical expenditure [1,2,3,4]. In 2006, we implemented an active screening program to analyze the active screening program with extensive bacteriological examination on febrile patients after cardiothoracic surgery, with the aim of early detection and treatment of serious systemic infection. The purpose of the study is to describe how various clinical characteristics and perioperative factors affect early diagnosis of postoperative sternal wound infection, focusing on the significance of routine blood culture protocols in identifying sternal wound infection and prioritizing opportunities for inter vention
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