title: A rifampicin-containing antibiotic treatment improves outcome of staphylococcal deep sternal wound infections.
abstract: BACKGROUND
  Deep sternal wound infection (DSWI) is a severe complication after cardiac surgery, mostly caused by staphylococci. Little is known about the optimal antibiotic management.
  
  
  METHODS
  A 10 year retrospective analysis of 100 patients with staphylococcal DSWI after cardiac surgery in a tertiary hospital. Treatment failure was defined as sternal wound dehiscence or fistula at the end of the prescribed antibiotic therapy, 12 months later, or DSWI-related death.
  
  
  RESULTS
  Most patients were male (83%) and the median age was 72 years [interquartile range (IQR) 63-76]. Coronary artery bypass was the most frequent preceding procedure (93%). The median time to diagnosis of DSWI was 13 days (IQR 10-18) after surgery. Clinical presentation consisted of wound discharge in 77% of patients. Coagulase-negative staphylococci were isolated in 54 and Staphylococcus aureus in 46 patients. All patients received antibiotics and 95% underwent surgical debridement. The median duration of antibiotic treatment was 47 days (IQR 41-78). During follow-up, 21 out of 100 patients experienced treatment failure. Of these, 8/21 patients (38%) died from DSWI after a median of 12 days (IQR 8-30). In the multivariate analysis, a rifampicin-containing antibiotic regimen was the only factor associated with lower risk of treatment failure (hazard ratio 0.26, 95% confidence interval 0.10-0.64, P = 0.004). Prolonged treatment (12 weeks instead of 6 weeks) did not alter outcome (P = 0.716) in patients without prosthetic valve endocarditis.
  
  
  CONCLUSIONS
  Treatment of rifampicin-susceptible staphylococcal DSWI with a rifampicin-containing antibiotic regimen may improve the outcome. After surgical debridement an antibiotic treatment of 6 weeks may be adequate for staphylococcal DSWI.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Bettina
authors.initials: B
authors.lastname: Khanlari
authors.forename: Luigia
authors.initials: L
authors.lastname: Elzi
authors.forename: Laura
authors.initials: L
authors.lastname: Estermann
authors.forename: Maja
authors.initials: M
authors.lastname: Weisser
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Brett
authors.forename: Martin
authors.initials: M
authors.lastname: Grapow
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.forename: Ursula
authors.initials: U
authors.lastname: Flückiger
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D013210:Staphylococcus / Q000145:classification / Q000302:isolation & purification*; D013249:Sternum / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D012293:Rifampin