title: A retrospective study of deep sternal wound infections: clinical and microbiological characteristics, treatment, and risk factors for complications.
abstract: Deep sternal wound infection (DSWI) is a feared complication following cardiac surgery. This study describes clinical, microbiological, and treatment outcomes of DSWI and determines risk factors for complications. Of 55 patients with DSWI, 66% were male and mean age was 68.2 years. Initial sternotomy was for coronary artery bypass graft in 49% of patients. Sternal debridement at mean 25.4±18.3 days showed monomicrobial (94%), mainly Gram-positive infection. Secondary sternal wound infection (SSWI) occurred in 31% of patients, was mostly polymicrobial (71%), and was predominantly due to Gram-negative bacilli. Risk factors for SSWI were at least 1 revision surgery (odds ratio [OR] 4.8 [95% confidence interval {CI} 1.0-22.4], P=0.047), sternal closure by muscle flap (OR 4.6 [1.3-16.8], P=0.02), delayed sternal closure (mean 27 versus 14 days, P=0.03), and use of vacuum-assisted closure device (100% versus 58%, P=0.008). Hospital stay was significantly longer in patients with SSWI (69 days versus 48 days, P=0.04).
authors.affiliation: Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Monica
authors.initials: M
authors.lastname: Chan
authors.affiliation: Septic Surgery Unit, Lausanne University Hospital, Lausanne, Switzerland; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland. Electronic address: angga.yusuf@gmail.com.
authors.forename: Erlangga
authors.initials: E
authors.lastname: Yusuf
authors.affiliation: Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Giulieri
authors.affiliation: Septic Surgery Unit, Lausanne University Hospital, Lausanne, Switzerland; Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Nancy
authors.initials: N
authors.lastname: Perrottet
authors.affiliation: Cardiovascular Surgery, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Von Segesser
authors.affiliation: Septic Surgery Unit, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Borens
authors.affiliation: Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000382:microbiology*; D014946:Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy
keywords: Deep sternal wound infection; Negative pressure wound therapy; Post-operative mediastinitis; Sternal osteomyelitis; Sternotomy