title: Sternal puncture allows an early diagnosis of poststernotomy mediastinitis.
abstract: OBJECTIVE
  Poststernotomy mediastinitis after cardiac operations is a nosocomial infection involving the mediastinal space and the sternum, with a high mortality rate mostly related to a late diagnosis. We investigated whether sternal puncture might facilitate and shorten the delay in the diagnosis of mediastinitis.
  
  
  METHODS
  Of 1024 patients undergoing sternotomy for cardiac surgery, sternal puncture was performed in a subgroup of 49 patients in whom mediastinitis was suspected.
  
  
  RESULTS
  Sternal puncture culture results were positive for all patients with true mediastinitis (n = 23) and negative in 24 of 26 patients without mediastinitis. In addition, sternal puncture allowed diagnosis of mediastinitis with a shorter delay (9 +/- 5 days vs 13 +/- 8 days, P =.04) and caused a reduction in the length of mechanical ventilation (3 +/- 4 days vs 10 +/- 13 days, P =.02) and stay in the intensive care unit (9 +/- 7 days vs 18 +/- 15 days, P =.02) compared with that found in another group of patients (n = 20) operated on for true mediastinitis on the basis of the presence of classic, delayed, clinical signs.
  
  
  CONCLUSIONS
  Our study shows that sternal puncture is a rapid and safe method to ensure the diagnosis of poststernotomy mediastinitis.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Institut Fédératif de Recherches Circulation, Hôpital Lariboisière, Paris, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Benlolo
authors.forename: Joaquim
authors.initials: J
authors.lastname: Matéo
authors.forename: Laurent
authors.initials: L
authors.lastname: Raskine
authors.forename: Omar
authors.initials: O
authors.lastname: Tibourtine
authors.forename: Alain
authors.initials: A
authors.lastname: Bel
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001431:Bacteriological Techniques / Q000379:methods* / Q000592:standards; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D003646:Debridement; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D011446:Prospective Studies; D011677:Punctures / Q000379:methods* / Q000592:standards; D012680:Sensitivity and Specificity; D013249:Sternum; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome