Sternal wound infection caused by Mycobacterium chelonae.
BACKGROUND
Sternal wound infection caused by Mycobacterium chelonae, a member of the rapidly growing nontuberculous mycobacteria (NTM), is rare and may present without signs and symptoms of systemic infection.


METHODS
We present a patient who had a M. chelonae infection of the sternum following excision of a left atrial myxoma and conducted a review of the literature from 1976 to 2013.


RESULTS
Seventy cases of NTM sternal wound infection after cardiac surgery were identified, including six outbreaks and ten sporadic cases including the present case. Thirty-four cases were isolated coronary artery bypass grafting (CABG) surgery, 16 cases were isolated valve replacement, and two cases were valve replacement with CABG. The age range of the patients was between 6 and 78 years. The average time from the surgery was 49 ± 58 days which was longer than the usual bacterial mediastinitis. The overall mortality rate was 29%.


CONCLUSIONS
NTM sternal wound infection is rare but may be fatal if not properly treated. The toxic signs are often subtle and it will take longer to isolate compared to typical bacterial mediastinitis. Early recognition, the use of appropriate antibiotics based on susceptibility tests, and aggressive surgical debridement are required for full recovery.
Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Shinya
S
Unai
Joseph
J
Miessau
Pawel
P
Karbowski
Gurjyot
G
Bajwa
Hitoshi
H
Hirose
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006325:Heart Atria; D006338:Heart Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000031:analogs & derivatives; D009165:Mycobacterium Infections, Nontuberculous / Q000382:microbiology* / Q000628:therapy*; D016926:Mycobacterium chelonae / Q000302:isolation & purification*; D009232:Myxoma / Q000601:surgery*; D010369:Pectoralis Muscles / Q000637:transplantation; D056346:Sternotomy; D013249:Sternum; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000628:therapy*; D019616:Thoracic Surgical Procedures / Q000379:methods; D000078304:Tigecycline; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000078304:Tigecycline; D008911:Minocycline; D017291:Clarithromycin