title: Defining post-sternotomy mediastinitis for clinical evidence-based studies.
abstract: BACKGROUND
  Considerable advances have already been made in the treatment of deep thoracic wound infections following a median sternotomy for cardiac surgery. Further improvement in diagnosis, treatment, and outcome will require a targeted approach by multidisciplinary teams. Clear communication and synergy between the various clinical and supportive disciplines would assist in removing the last barriers to standardized evidence-based studies and the development of improved evidence-based guidelines.
  
  
  METHODS
  An extensive literature search without language restrictions was carried out on PubMed (Medline), EMBASE, and Web of Science, covering the period 1988 to week 16, 2014, and a manual search of the reference lists was performed regarding all possible definitions and classifications of post-sternotomy mediastinitis. Two hundred and eighteen papers describing post-sternotomy infections in a multitude of terms were identified, and the strengths and weaknesses of the most popular definitions and terms relating specifically to post-sternotomy infections were examined.
  
  
  RESULTS
  This study revealed that clinicians use a multitude of terms to describe post-sternotomy infections without defining the condition under treatment. Occasionally, older epidemiological (surveillance) definitions were used. It also shows that supportive disciplines have their own definitions, or interpretations of existing definitions, to describe these infections.
  
  
  CONCLUSIONS
  The outcome of this study is that clinicians have adopted no single definition, which is essential for further improvement for evidence-based studies. We suggest that it is possible to adopt a single term for thoracic infection after a sternotomy (and only sternotomy), and propose a clinical definition for this purpose.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Academic Medical Center, University of Amsterdam, The Netherlands j.j.vanwingerden@amc.uva.nl.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: van Wingerden
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Plastic and Reconstructive Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Chantal M A M
authors.initials: CM
authors.lastname: van der Horst
mesh_terms: D032921:Consensus; D006801:Humans; D008480:Mediastinitis / Q000145:classification* / Q000175:diagnosis / Q000382:microbiology; D056346:Sternotomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000145:classification* / Q000175:diagnosis / Q000382:microbiology; D009626:Terminology as Topic; D016896:Treatment Outcome
keywords: Mediastinitis; Mediastinum; Sternotomy; Surgical wound infection