title: Candida albicans sternal wound infections: a chronic and recurrent complication of median sternotomy.
abstract: Eleven patients developed deep sternal wound infections due to Candida albicans after undergoing coronary artery bypass grafting (CABG) and were assessed. Six had sternal osteomyelitis, 1 had osteomyelitis and mediastinitis, and 4 had deep wound infections that probably involved bone. Seven patients experienced onset of infection within 28 days of CABG, but 4 experienced onset 48-150 days after CABG. Infections were characterized by a chronic, indolent course requiring prolonged treatment with an antifungal agent. Delay in initiating antifungal therapy was common. All patients were treated with fluconazole, and 1 also received amphotericin B. Six patients underwent incision and drainage, with or without wire removal, and 3 underwent sternectomy with placement of a muscle flap. Of 10 patients for whom follow-up data were available, 7 were cured after initial therapy (median duration of treatment, 6 months), and 3 experienced a relapse and required a second course of fluconazole.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
authors.forename: Preeti N
authors.initials: PN
authors.lastname: Malani
authors.forename: Shelly A
authors.initials: SA
authors.lastname: McNeil
authors.forename: Suzanne F
authors.initials: SF
authors.lastname: Bradley
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans; D002177:Candidiasis / Q000188:drug therapy / Q000503:physiopathology* / Q000517:prevention & control; D002908:Chronic Disease; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology*; D012008:Recurrence; D013249:Sternum / Q000382:microbiology; D016896:Treatment Outcome; D014946:Wound Infection / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents