Role of Epicardial Pacing Wire Cultures in the Diagnosis of Poststernotomy Mediastinitis

Maroto, Luis; Aguado, J. M.; Carrascal, Yolanda; Perez, Ana Belen Dueñas; Pérez-de-la-Sota, Enrique; Cortina, José M.; Delgado, Rafaël; Rodrı́guez, Enrique; Molina, L; Rufilanchas, Juan J.

doi:10.1093/clinids/24.3.419

Cited by 26 publications

(19 citation statements)

References 7 publications

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“…Pacing wires are fixed in the pericardium at the end of cardiac surgery operations and can be considered microbiological samples of the anterior mediastinum. Three previous studies have evaluated the accuracy of EPW cultures in the early prediction of PSM (2,8,12), but these series comprised small numbers of patients with PSM, …”

Section: Discussionmentioning

confidence: 99%

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Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Mekontso-Dessap

Honore²,

Kirsch

et al. 2004

J Clin Microbiol

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Poststernotomy mediastinitis (PSM) is one of the most serious complications of cardiac surgery, and its associated morbidity and mortality demand early recognition for emergency therapy. In this study, we investigated the usefulness of epicardial pacing wire (EPW) cultures for the prediction of PSM. Among 2,200 patients who underwent a cardiac surgical procedure at our hospital between 1 January 1999 and 31 December 2001, 82 (3.7%) had PSM; Staphylococcus aureus was the organism (45.1%) most frequently isolated at the time of surgical debridement. EPWs from 1,607 (73.0%) patients, 73 (4.5%) of whom developed PSM, were cultured. EPW cultures from 466 (29.0%) were positive, most often (74.9%) for coagulase-negative Staphylococci. EPW cultures were truly positive in 26 cases, truly negative in 1,106 cases, falsely positive in 428 cases, and falsely negative in 47 cases (with sterile cultures in 35 cases and a culture positive for an organism different from that isolated at the time of debridement in 12 cases). EPW culture had a positive predictive value of only 5.7% and a high negative predictive value (95.9%) for the diagnosis of PSM, with an accuracy of 70.4%. However, the likelihood ratio of positive (1.27) and negative (0.89) tests indicated only small changes in pretest-to-posttest probability. Therefore, a strategy of routine culture of EPWs to predict PSM seems questionable.Poststernotomy mediastinitis (PSM) is a life-threatening complication that occurs in about 1 to 5% of cardiac surgery procedures. PSM is associated with major patient morbidity, mortality, and cost (11). Successful management of this infection requires early diagnosis and aggressive treatment (5). In fact, the prognosis for patients with PSM appears to be related to the length of time required for the institution of treatment (4). The diagnosis of PSM is sometimes straightforward, and it is established by physical examination of the wound and by conventional laboratory studies. However, diagnosis in the early stages where treatment is the most effective is often difficult, and multiple diagnostic procedures are sometimes necessary to ascertain the infectious process.Epicardial pacing wires (EPWs) are fixed in the pericardium at the end of cardiac surgery procedures to treat postoperative bradyarrythmias. Some authors have suggested that EPW cultures might be helpful in the early diagnosis of PSM (2,8,12). However, these studies included only a small number of patients with PSM (35 patients in all). The present study was undertaken to evaluate our strategy of routine EPW culture and its contribution to identification of PSM at an early stage. MATERIALS AND METHODS Study population.All patients who underwent a cardiac surgical procedure via median sternotomy between 1 January 1999 and 31 December 2001 at Henri Mondor University Hospital (Créteil, France) were studied. Body hair was removed the day before operation with a clipper. Patients showered the night and morning before surgery with a povidone-iodine solution (or chlorhexidine in case...

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Section: Discussionmentioning

confidence: 99%

“…Some authors have suggested that EPW cultures might be helpful in the early diagnosis of PSM (2,8,12). However, these studies included only a small number of patients with PSM (35 patients in all).…”

mentioning

confidence: 99%

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Mekontso-Dessap

Honore²,

Kirsch

et al. 2004

J Clin Microbiol

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“…Because of this limitation, a variety of diagnostic approaches to the diagnosis of mediastinitis have been evaluated, including aspiration of the mediastinal space, 14,15 ␣ 1 acid glycoprotein and C-reactive protein measurements, 16 procalcitonin level, 17 and culture of perioperative instruments. 18 Even advanced, expensive methods of radiographic imaging such as computed tomography, 19,20 fluorine-18 fluorodeoxyglucose positron emission tomography, 21,22 gallium-67 scintigraphy, 23 99Tcm-labeled leukocyte scintigraphy, 24,25 or single photon emission computed tomography with 99mTc-hexamethylpropylene amine oxime-labeled leukocytes 26 are either of limited benefit in identifying patients with postoperative mediastinitis or are widely unavailable. For example, the sensitivity and positive predictive value of computed tomography in the diagnosis of mediastinitis were as low as 25% and 71%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Staphylococcus aureus Bacteremia After Median Sternotomy

et al. 2003

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Background-Mediastinitis is a complication of coronary artery bypass graft surgery (CABG) that can be difficult to diagnose. This study evaluated the utility of blood culture results in identifying patients with mediastinitis. Methods and Results-All unique patients undergoing CABG at our institution over a 60-month study period (nϭ5500) and all blood cultures performed on these patients Յ90 days after CABG were identified.

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“…Epicardial pacing wire cultures are not satisfactory for the diagnosis of mediastinitis [50] , while bacteriological samples from the sternal or retrosternal puncture are considered safe and powerful [51] . CT scans have been considered of great value to localize infected tissues [52] , however, there is also some doubt about the validity of a CT scan in performing an early diagnosis [53,54] .…”

Section: Diagnosismentioning

confidence: 99%

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

Durandy¹

2010

WJC

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In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.

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Role of Epicardial Pacing Wire Cultures in the Diagnosis of Poststernotomy Mediastinitis

Cited by 26 publications

References 7 publications

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Staphylococcus aureus Bacteremia After Median Sternotomy

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

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