Sternal osteomyelitis complicating percutaneous coronary artery stenting.
Hematogenous sternal osteomyelitis is a rare infection that has been associated with i.v drug abuse and blunt thoracic trauma, but iatrogenic infections have also been described following resuscitation and in conjunction with hemodialysis catheters. Staphylococcus aureus is the most common causative organism. Stenting is the preferred treatment for isolated stenosis of the coronary artery and is associated with a low complication rate and high patency rate. Such intravascular procedures are rarely complicated by infections. A 72-year-old man developed hematogenous sternal osteomyelitis following coronary artery stenting. Radiological diagnosis was made using CT scan and MRI, and blood cultures and aspiration fluid from the infected soft tissue were positive for S. aureus. Initial therapy consisted of i.v. second-generation cephalosporin followed by oral cephalexin and later linezolid. Prolonged antibiotic therapy without surgical intervention was successful in controlling this rare complication. The patient was well at the one-year follow up, with patent stent and no signs for recurrent osteomyelitis. Although transcutaneous stenting is a widely accepted strategy for treating stenosed arteries, this case highlights the possibility of hazardous infectious complications associated with such procedures.
Bonatti
Hugo
H
Department of General and Transplant Surgery, Innsbruck University Hospital, Innsbruck, Austria. Hugo.Bonatti@uklibk.ac.at
Berger
Thomas
T
Waltner-Romen
Maria
M
Bodner
Gerd
G
Hengster
Paul
P
Antretter
Herwig
H
Friedrich
Guy
G
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis / Q000209:etiology*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology*; D015607:Stents / Q000009:adverse effects*; D013249:Sternum; D016896:Treatment Outcome