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. 2015 Sep 30;10(9):e0139122.
doi: 10.1371/journal.pone.0139122. eCollection 2015.

Sternal Wound Infection after Cardiac Surgery: Management and Outcome

Marie Dubert  1 , Annabelle Pourbaix  1 , Soleiman Alkhoder  2 , Guillaume Mabileau  3 , François-Xavier Lescure  4 , Walid Ghodhbane  2 , Sabine Belorgey  5 , Christophe Rioux  1 , Laurence Armand-Lefèvre  6 , Michel Wolff  7 , Richard Raffoul  2 , Patrick Nataf  2 , Yazdan Yazdanpanah  4 , Jean-Christophe Lucet  8
Affiliations

Sternal Wound Infection after Cardiac Surgery: Management and Outcome

Marie Dubert et al. PLoS One. .

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.

Conclusion: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of Patients with Sternal Wound Infection Requiring Reoperation after Cardiac Surgery.
See this image and copyright information in PMC

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