Sternal puncture allows an early diagnosis of poststernotomy mediastinitis.
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.
Benlolo
Sidney
S
Department of Anesthesiology and Critical Care Medicine, Institut Fédératif de Recherches Circulation, Hôpital Lariboisière, Paris, France.
Matéo
Joaquim
J
Raskine
Laurent
L
Tibourtine
Omar
O
Bel
Alain
A
Payen
Didier
D
Mebazaa
Alexandre
A
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