title: Sternal Wound Infection after Cardiac Surgery: Management and Outcome.
abstract: BACKGROUND
  Sternal Wound Infection (SWI) is a severe complication after cardiac surgery. Debridement associated with primary closure using Redon drains (RD) is an effective treatment, but data on RD management and antibiotic treatment are scarce.
  
  
  METHODS
  We performed a single-center analysis of consecutive patients who were re-operated for SWI between 01/2009 and 12/2012. All patients underwent a closed drainage with RD (CDRD). Patients with endocarditis or those who died within the first 45 days were excluded from management analysis. RD fluid was cultured twice weekly. Variables recorded were clinical and biological data at SWI diagnosis, severity of SWI based on criteria for mediastinitis as defined by the Centers for Disease Control (CDC), antibiotic therapy, RD management and patient's outcome.
  
  
  RESULTS
  160 patients developed SWI, 102 (64%) fulfilled CDC criteria (CDC+) and 58 (36%) did not (CDC- SWI). Initial antibiotic treatment and surgical management were similar in CDC+ and CDC- SWI. Patients with CDC+ SWI had a longer duration of antibiotic therapy and a mortality rate of 17% as compared to 3% in patients with CDC- SWI (p = 0.025). Rates of superinfection (10% and 9%) and need for second reoperation (12% and 17%) were similar. Failure (death or need for another reoperation) was associated with female gender, higher EuroScore for prediction of operative mortality, and stay in the ICU.
  
  
  CONCLUSIONS
  In patients with SWI, initial one-stage surgical debridement with CDRD is associated with favorable outcomes. CDC+ and CDC- SWI received essentially the same management, but CDC+ SWI has a more severe outcome.
authors.affiliation: Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Dubert
authors.affiliation: Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Pourbaix
authors.affiliation: Cardiac Surgery Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Soleiman
authors.initials: S
authors.lastname: Alkhoder
authors.affiliation: IAME, UMR 1137, INSERM, F-75018, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Mabileau
authors.affiliation: Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; IAME, UMR 1137, INSERM, F-75018, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Lescure
authors.affiliation: Cardiac Surgery Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Walid
authors.initials: W
authors.lastname: Ghodhbane
authors.affiliation: Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Belorgey
authors.affiliation: Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Rioux
authors.affiliation: Bacteriology Laboratory, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefèvre
authors.affiliation: IAME, UMR 1137, INSERM, F-75018, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France; Medical Intensive Care Unit, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.affiliation: Cardiac Surgery Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Raffoul
authors.affiliation: Cardiac Surgery Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.affiliation: Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; IAME, UMR 1137, INSERM, F-75018, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: IAME, UMR 1137, INSERM, F-75018, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France; Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents