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Review of Common Pathogens in Deep Sternal Wounds, Blood Stream and Bone Infections in Patients Following Sternotomy: A 10 Year Follow up

Michal Benkler, Ori Shulman, Yoav Avrahamy, David Mendes, Yoav Erosh, Ron Fishel, David Ben Harosh, Amos Leviav and Dana Egozi

Background: Deep sternal wound infections, mediastinitis and sternal osteomyelitis are devastating and life-threatening complications of median-sternotomy incisions after cardiac surgical procedures. The incidence of surgical wound infection in sternotomies is relatively high among heart disease patients since these patients are burdened with a high number of risk factors compared to the general population.

Purpose: This study focusses on microbiological data of deep sternal wounds, alongside blood and bone cultures to help define early and appropriate antibiotic therapy following debridement and reconstructive surgery. Furthermore, this study discusses whether antibiotic treatment of sepsis can rely on preliminary wound cultures.

Results: The most commonly cultured organism from deep sternal wound infections was Staphylococcus and the most commonly cultured Gram-negative organism was Pseudomonas. All Gram-negative organisms combined together represented approximately 50% of all cultures. We found that 37% of blood culture pathogens were initially found in wound cultures, and 14% of blood culture organisms were first identified in bone cultures. From a different prespective, 16% of the organisms isolated from the wound and 26% of the organisms isolated from the bone were later found to involve the blood.

Conclusions: The initial antibiotic regimen should be broad spectrum, covering both Gram-positive and Gram-negative organisms. We demonstrate that for osteomyelitis of the sternum, antibiotic treatment for a relatively short period of two weeks is adequate alongside thorough debridement and reconstruction with a vascularized soft tissue flap (pectoral major). Furthermore, the initial antibiotic regimen during sepsis may partially rely on preliminary wound cultures since a third of the pathogens found in the blood were first identified in wound cultures.