Poststernotomy mediastinitis.

The clinician should suspect mediastinitis in patients after sternotomy who have unexplained fever or leukocytosis, sternal wound tenderness, or atypical chest or neck discomfort 2 to 3 weeks following surgery. Mediastinitis should be considered if any of these features are present. The diagnosis should be aggressively pursued by mediastinal aspiration via the suprasternal notch. Early empiric treatment with an antibiotic(s) with antistaphylococcal and gram-negative coverage is critical to survival.