SURGICAL WOUND INFECTIONS AFTER MEDIAN STERNOTOMY: CLINICAL AND MICROBIOLOGIC PRELIMINARY RESULTS OF A LARGE MULTICENTRE STUDY IN ITALY

Objectives: Sternal wound infections (SWIs) after median sternotomy are associated with high mortality and morbidity. Prevention, early diagnosis and adeguate treatment are essential, but consensus abiut the preoperative management and the best surgical treatment strategy is still lacking. The aim of the study was to evaluate the incidence of SWI, the occurrence of the known risk factors, the clinical and microbiologic features and the current therapeutic approaches in a large series of patients. Methods: Nineteen divisions of Cardiac Surgery spread all over Italy participated in a prospective, observational study. Pre, intra and postoperative risk factors of all the patients undergoing median sternotomy in the first week of every month from October 2005 to July 2006 were recorded. Further data were recorded for all the patients who developed SWI. Results: Overall, 1,746 patients were evaluated. Characteristics of the patients are reported in Table 1. All patients received antibiotic prophylaxis for a mean duration of 46.5 hours. Overall 76.1% received cefazolin, cefuroxime or cefamandole, 24.7% had glycopeptides (8.1% as single dose combined to other regimens) and 4.8% received ampicillinsulbactam or amoxicillin-clavulanate, 1.1% carbapenems and 1.2% other antibiotics. Forty-six patients developed SWIs (2.7%); 78.5% were due to Staphylococci. Deep SWIs were 26 (19 sternal osteomyelitis and 7 mediastinitis) and required reoperation (73%), mediastinal irrigation (30.7%), closed mediastinal drainage (19.2%), vacuum continuous aspiration (30.7%) and plastic surgery (23%). Forty-four patients recovered (95.6%) and 1 died for mediastinitis.