Abstract
BackgroundSternal Wound Infection (SWI) is a severe complication after cardiac surgery. Debridement associated with primary closure using Redon drains (RD) is an effective treatment, but data on RD management and antibiotic treatment are scarce.MethodsWe performed a single-center analysis of consecutive patients who were re-operated for SWI between 01/2009 and 12/2012. All patients underwent a closed drainage with RD (CDRD). Patients with endocarditis or those who died within the first 45 days were excluded from management analysis. RD fluid was cultured twice weekly. Variables recorded were clinical and biological data at SWI diagnosis, severity of SWI based on criteria for mediastinitis as defined by the Centers for Disease Control (CDC), antibiotic therapy, RD management and patient’s outcome.Results160 patients developed SWI, 102 (64%) fulfilled CDC criteria (CDC+) and 58 (36%) did not (CDC- SWI). Initial antibiotic treatment and surgical management were similar in CDC+ and CDC- SWI. Patients with CDC+ SWI had a longer duration of antibiotic therapy and a mortality rate of 17% as compared to 3% in patients with CDC- SWI (p = 0.025). Rates of superinfection (10% and 9%) and need for second reoperation (12% and 17%) were similar. Failure (death or need for another reoperation) was associated with female gender, higher EuroScore for prediction of operative mortality, and stay in the ICU.ConclusionIn patients with SWI, initial one-stage surgical debridement with CDRD is associated with favorable outcomes. CDC+ and CDC- SWI received essentially the same management, but CDC+ SWI has a more severe outcome.
Highlights
Sternal wound infection (SWI) still is a frequent complication after sternotomy for cardiac surgery, with an incidence of 0.5 to 3% [1,2,3,4]
Initial antibiotic treatment and surgical management were similar in Centers for Disease Control and Prevention (CDC)+ and CDC- SWI
Patients with CDC+ SWI had a longer duration of antibiotic therapy and a mortality rate of 17% as compared to 3% in patients with CDC- SWI (p = 0.025)
Summary
Sternal wound infection (SWI) still is a frequent complication after sternotomy for cardiac surgery, with an incidence of 0.5 to 3% [1,2,3,4]. Variations in definition partly explain the large range of infection rates. Other authors proposed a broader definition, including infection of presternal tissue requiring reoperation, sternal osteomyelitis and mediastinitis [6]. The incidence of mediastinitis has barely declined over the last decades. This may be explained by the fact that cardiac surgery is more frequently performed in patients with higher risk of infection, despite improvement in preventive measures. Sternal Wound Infection (SWI) is a severe complication after cardiac surgery. Debridement associated with primary closure using Redon drains (RD) is an effective treatment, but data on RD management and antibiotic treatment are scarce
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