Arterial grafting and the risk of sternal infection: How we can learn from our experience

Kurlansky, Paul

doi:10.1016/j.jtcvs.2014.09.097

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…Data from the Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database reported an overall DSWI incidence of 0.3% for isolated CABG in 2007. This decreased further to 0.2% in the most recent 2014 report [19].…”

Section: Declining Incidence Of Deep Sternal Wound Infectionsmentioning

confidence: 79%

Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting

Zia

Hasan

Ilyas

et al. 2020

Surgical Infections

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Background: Although the survival advantage of bilateral internal thoracic artery grafting (BITA) is well known in patients undergoing coronary artery bypass grafting (CABG), this technique has not been widely adopted. This is mainly because of the increased risk of deep sternal wound infections (DSWI) associated with its use. However, in recent years the overall risk of DSWI has decreased. This is mainly because of strategies that have been adopted to decrease the risk of these infections in patients undergoing CABG. Conclusion: In this review we identified DSWI preventive strategies and described them in detail so that their use by surgeons can be increased. This would minimize the risk of DSWI after BITA grafting and maximize the use of this highly effective surgical technique.

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Section: Declining Incidence Of Deep Sternal Wound Infectionsmentioning

confidence: 79%

Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting

Zia

Hasan

Ilyas

et al. 2020

Surgical Infections

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“…The reported incidence of poststernotomy mediastinitis (PSM) after cardiac surgery is approximately 3%. 1 Despite its low incidence, PSM is associated with high mortality rate (up to 46%), 2 prolonged hospital stay, and increased medical expenses; in addition, PSM adversely affects the long-term survival of these patients. According to a recent guideline, delayed PSM diagnosis is associated with a worse prognosis and early diagnosis reduces the number of secondary interventions to control PSM and thereby the risk for patients.…”

Section: Introductionmentioning

confidence: 99%

Routine Mediastinal Drainage Fluid Culture for Early Diagnosis of Poststernotomy Mediastinitis

Jung

Lee

et al. 2022

Thorac Cardiovasc Surg

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Background Early diagnosis of poststernotomy mediastinitis (PSM) is challenging. Since 2016, we have routinely performed mediastinal drainage fluid culture (MDFC) in patients undergoing sternotomy. This study aimed to determine the utility of MDFC for early diagnosis of PSM. Methods Between November 2016 and April 2020, we conducted MDFC in 1,012 patients on the third postoperative day and prospectively observed for PSM occurrence for 3 months. If bacteria were identified, additional MDFC or blood culture was performed to reduce the possibility of false positives. Based on MDFC results, the decision for early treatment for PSM was at the attending physician's discretion. Results Bacteria were identified in MDFC of 29 patients, eight of whom subsequently developed PSM. Among 983 patients with negative MDFC, only 15 developed PSM. In multivariate analysis, previous sternotomy history and positive MDFC were predictors of PSM. Positive MDFC was regarded as true positive if (1) PSM occurred subsequently, and/or (2) the same bacteria were identified in additional MDFC/blood culture. Non-occurrence of PSM in the absence of antibiotic treatment was regarded as false-positive MDFC. The sensitivity, specificity, and positive and negative predictive values of routine MDFC for diagnosis of mediastinal infection were 46.4, 99.0, 56.5, and 98.5%, respectively. When categorizing cases with positive MDFC based on the identified bacteria, the positive predictive value was highest (76.9%) when Staphylococci were identified. Conclusion Routine MDFC after sternotomy can facilitate early diagnosis of PSM. Early treatment for PSM may be indicated in patients in whom Staphylococci are identified in the MDFC.

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Diagnosing poststernotomy mediastinitis in the ED

Wingerden

Maas

Braam

et al. 2016

The American Journal of Emergency Medicine

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Arterial grafting and the risk of sternal infection: How we can learn from our experience

Cited by 5 publications

References 25 publications

Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting

Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting

Routine Mediastinal Drainage Fluid Culture for Early Diagnosis of Poststernotomy Mediastinitis

Diagnosing poststernotomy mediastinitis in the ED

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