Steingrimsson Steinn, Gottfredsson Magnus, Gudmundsdottir Ingibjorg, Sjögren Johan, Gudbjartsson Tomas
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):406-10. doi: 10.1093/icvts/ivs254. Epub 2012 Jun 12.
To evaluate the outcome of treatment for deep sternal wound infection (DSWI) in a nationwide patient cohort, before and after the introduction of negative-pressure wound therapy (NPWT).
This was a population-based cohort of all patients treated for DSWI in Iceland out of 2446 open heart operations performed between 2000 and 2010. Length of hospital stay, survival and reoperations were compared in (i) 23 patients treated with open and/or closed irrigation before August 2005 (conventional treatment, CvT group) and in (ii) 20 patients treated after this time with NPWT as a first-line therapy (NPWT group).
The DSWI rate was 1.8% and did not change during the study period. Demographics were similar for both groups, except for peripheral arterial disease which was less common in the NPWT group. Coagulase-negative staphylococci were also more common (as the only pathogen identified) in the NPWT group (70% vs 30%, P = 0.01). The median length of hospital stay was 43 days in both groups and the sternum could be closed with delayed primary closure in all except 2 patients, one in each group. Eight patients in the CvT group required surgical revision for re-infections, including debridement and rewiring, when compared with 1 patient in the NPWT group (P = 0.02). Furthermore, 6 patients in the CvT group developed late chronic infections of the sternum requiring surgical revision, compared with one in the NPWT group (P = 0.10). The 30-day mortality was not significantly different between groups (4% vs 0%, P > 0.1) and the same was true for 1-year mortality (17% vs 0%, P = 0.11).
NPWT significantly reduces the risk of early re-infections in patients with DSWI. There was a lower rate of late chronic sternal infections and lower mortality in the NPWT group, but the difference was not statistically significant. We conclude that NPWT should be considered as a first-line treatment for most DSWIs.
评估在全国范围内的患者队列中，在引入负压伤口治疗（NPWT）前后，深部胸骨伤口感染（DSWI）的治疗结果。
这是一个基于人群的队列研究，研究对象为2000年至2010年间在冰岛接受2446例心脏直视手术治疗DSWI的所有患者。比较了（i）2005年8月前接受开放和/或闭合冲洗治疗的23例患者（传统治疗，CvT组）和（ii）此后接受NPWT作为一线治疗的20例患者（NPWT组）的住院时间、生存率和再次手术情况。
DSWI发生率为1.8%，在研究期间未发生变化。两组的人口统计学特征相似，但NPWT组外周动脉疾病较少见。凝固酶阴性葡萄球菌在NPWT组中也更常见（作为唯一鉴定出的病原体，70%对30%，P = 0.01）。两组的中位住院时间均为43天，除每组各有1例患者外，所有患者的胸骨均可通过延迟一期缝合闭合。与NPWT组的1例患者相比，CvT组有8例患者因再次感染需要手术翻修，包括清创和重新布线（P = 0.02）。此外，CvT组有6例患者发生胸骨晚期慢性感染需要手术翻修，而NPWT组为1例（P = 0.10）。两组的30天死亡率无显著差异（4%对0%，P > 0.1），1年死亡率也是如此（17%对0%，P = 0.11）。
NPWT显著降低了DSWI患者早期再次感染的风险。NPWT组晚期慢性胸骨感染率较低，死亡率也较低，但差异无统计学意义。我们得出结论，对于大多数DSWI，NPWT应被视为一线治疗方法。
