Candida albicans sternal wound infections: a chronic and recurrent complication of median sternotomy.
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.
Malani
Preeti N
PN
Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
McNeil
Shelly A
SA
Bradley
Suzanne F
SF
Kauffman
Carol A
CA
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*
D000935:Antifungal Agents