Transposition of greater omentum in deep sternal wound infection caused by methicillin-resistant Staphylococci, with differing clinical course for MRSA and MRSE.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) are an increasing problem in deep sternal wound infections (DSWI) after cardiac surgery.


METHODS
Between 2005 and 2009, recalcitrant methicillin-resistant Staphylococcus was found in 21 patients with complicated DSWI, and a transposition of the greater omentum (TGO) was finally performed. A positive microbial culture at the time of procedure was present in all patients. The hospital course was reviewed discretely for MRSA and MRSE.


RESULTS
Median patient age was 72.3 years (range 60.8-79.7); 76 % of patients were male. Time from the first sternal revision until consecutive open wound therapy due to re-infection and total hospital stay was longer for MRSA compared to MRSE (38 vs. 14 days, P = 0.003, and 141 vs. 91 days, P = 0.007, respectively). The period from cardiac surgery to TGO was likewise prolonged for MRSA (78 vs. 55 days, P = 0.045), whereas in-hospital mortality and one-year mortality rate did not differ.


CONCLUSIONS
TGO remains a good treatment option for DSWI type IV. Microbial findings determine the clinical course; nevertheless in-hospital mortality remains low for both MRSA and MRSE infection.
Department of Thoracic and Cardiovascular Surgery, University Medical Center, Göttingen, Germany. bdanner@med.uni-goettingen.de
B C
BC
Danner
D
D
Zenker
V N
VN
Didilis
M
M
Grossmann
T
T
Stojanovic
R
R
Seipelt
T
T
Tirilomis
F A
FA
Schöndube
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009852:Omentum / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications* / Q000401:mortality / Q000601:surgery; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome