Original articleAdult cardiacEmerging Role of Candida in Deep Sternal Wound Infection
Section snippets
Patients and Methods
The study was approved by the local ethics committee, and no patient approval was considered necessary.
Results
We identified 76 patients with DSWI from 4222 eligible patients by the specific procedure code for reoperation for deep infection after cardiac operation. An additional 10 patients were retrieved from our clinical microbiology database with positive mediastinal tissue cultures. Chart review confirmed the diagnosis in all but 2 patients with sternal instability with neither clinical signs of DSWI nor positive mediastinal tissue cultures. One patient was excluded from further analysis because of
Comment
Several previous studies demonstrate that systemic Candida infections are associated with increased morbidity and mortality in critically ill patients [10, 11, 12]. Mortality attributable to candidemia in cardiothoracic ICU patients has been estimated to be as high as 33% [13]. The effect Candida infection in terms of mortality and morbidity in patients with DSWI has not been studied previously in a systematic fashion.
In our study, we found remarkable differences in mortality between the
References (24)
- et al.
Systemic candidiasis in intensive care units: a multicenter, matched-cohort study
J Crit Care
(2002) - et al.
Determinants of candidemia and candidemia-related death in cardiothoracic ICU patients
Chest
(2003) - et al.
Sternal wound infection after coronary artery bypass graft surgery: validation of existing risk scores
J Thorac Cardiovasc Surg
(2007) - et al.
Sternal and costochondral infections following open-heart surgeryA review of 2,594 cases
J Thorac Cardiovasc Surg
(1976) - et al.
A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures
Ann Thorac Surg
(1985) - et al.
Mediastinitis after aorto-coronary bypass surgery
Eur J Cardiothorac Surg
(1997) - et al.
Surgical-site infection after cardiac surgery: incidence, microbiology, and risk factors
Infect Control Hosp Epidemiol
(2005) - et al.
Incidence, microbiological findings, and clinical presentation of sternal wound infections after cardiac surgery with and without local gentamicin prophylaxis
Eur J Clin Microbiol Infect Dis
(2007) - et al.
Serious infectious complications of midsternotomy: a review of bacteriology and antimicrobial therapy
Scand J Infect Dis
(1990) - et al.
Postsurgical mediastinitis: a case-control study
Clin Infect Dis
(1997)
Superficial and deep sternal wound complications: incidence, risk factors and mortality
Eur J Cardiothorac Surg
Sternal surgical-site infection following coronary artery bypass graft: prevalence, microbiology, and complications during a 42 month period
Infect Control Hosp Epidemiol
Cited by (19)
First line treatment of Candida osteomyelitis of the sternum: Is there really a need for radical surgical debridement and reconstructive surgery in Candida osteomyelitis of the sternum after cardiac surgery?
2017, Journal of Plastic, Reconstructive and Aesthetic SurgeryStrategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting
2015, International Journal of SurgeryCitation Excerpt :Centers for Disease Control and prevention (CDC) criteria for the diagnosis of deep sternal wound infection are (1) organisms cultured from mediastinal tissue or fluid obtained during a surgical operation or needle aspiration, (2) evidence of mediastinitis seen during a surgical operation or histopathological examination, (3) atleast one of the following signs or symptoms with no other recognized cause; fever > 38 °C, chest pain or sternal instability and one of the following (i) purulent discharge from the mediastinal area, (ii) organisms cultured from the blood or discharge from mediastinal area (iii) mediastinal widening on X-ray [27]. The most common pathogens identified in deep sternal wound infections are Gram positive cocci, Staphylococcus epidermidis and Staphylococcus aureus account for more than two-third of cases [28–30]. Gram negative bacteria (E. coli, Pseudomonas species, Klebsiella) and Corynebacterium have been isolated in 5–22% of cases, while multiple pathogens are reported in upto one quarter of cases [14,29,30].
Mediastinitis
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious DiseasesPostoperative mediastinitis due to Candida tropicalis: First reported case in Morocco
2014, Journal de Mycologie MedicaleCitation Excerpt :Regarding the case we are reporting, the current emergence of fungal mediastinitis is due to a better recognition of the role of yeasts in this nosological entity. Candida species represents up to 7.5% of the isolates in mediastinitis, especially in patients receiving mechanical ventilation [17]. It is a serious complication with high-risk of mortality (40 to 60%) and difficulties of diagnosis [15].
Etiology of surgical site infections in patients undergoing cardiac surgical procedures
2013, Cirugia CardiovascularInvited Commentary
2009, Annals of Thoracic Surgery