AI Article Synopsis
- Sternal Wound Infection (SWI) is a serious complication following cardiac surgery, with initial treatment involving surgical debridement and closed drainage using Redon drains, though there is limited information on their management and antibiotic use.
- A study analyzed data from 160 patients who experienced SWI, revealing that individuals meeting the CDC criteria for severity (CDC+) had a higher mortality rate and required longer antibiotic treatment compared to those who did not (CDC-).
- Despite similar rates of superinfection and the need for further surgery between the two groups, the study concluded that initial management of SWI shows promising outcomes, with CDC+ wounds indicating more severe cases that require more intensive care.
Article 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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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589393 | PMC |
| http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0139122 | PLOS |
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