ABSTRACT
Background: Deep sternal wound infection (DSWI), or
mediastinitis, is a devastating complication of coronary artery bypass grafting
(CABG). This prospective study aimed to assess our management of DSWI in view
of the published literature. Methods: Over 2-years (ending in January 2016), 29
patients (20 males) developed DSWI amongst 520 patients who underwent standard
CABG surgeries (5.6%). Pre-, intra- and postoperative variables were
documented. Whenever possible, the infections were culture-verified. Besides
antibiotics, patients received one or more
of the following therapies: drainage, debridement, closed irrigation, sternal
re-wiring, vacuum-assisted closure (VAC), and
bone resection. Results: the male to female ratio was 2.2:1.
Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4
kg/m2. There were 18, 16 and 11 patients with diabetes mellitus
(DM), hypertension and chronic obstructive pulmonary disease (COPD)
respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients
with a mean time of 117.5 ± 23.3 minutes.
Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type
I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases
were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed.
Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to
other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%)
patients within 3 - 24 weeks while
two (6.9%) patients died within 30 days. Conclusion: We have identified six independent
risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB),
five of them are modifiable.