University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Department of Cardiac Surgery, University Heart Center Dresden, TU Dresden, Dresden, Germany.
BMC Infect Dis. 2023 May 25;23(1):349. doi: 10.1186/s12879-023-08340-7.
Deep sternal wound infection is a rare but feared complication of median thoracotomies and is usually caused by microorganisms from the patient's skin or mucous membranes, the external environment, or iatrogenic procedures. The most common involved pathogens are Staphylococcus aureus, Staphylococcus epidermidis and gram-negative bacteria. We aimed to evaluate the microbiological spectrum of deep sternal wound infections in our institution and to establish diagnostic and treatment algorithms.
We retrospectively evaluated the patients with deep sternal wound infections at our institution between March 2018 and December 2021. The inclusion criteria were the presence of deep sternal wound infection and complete sternal osteomyelitis. Eighty-seven patients could be included in the study. All patients received a radical sternectomy, with complete microbiological and histopathological analysis.
In 20 patients (23%) the infection was caused by S. epidermidis, in 17 patients (19.54%) by S. aureus, in 3 patients (3.45%) by Enterococcus spp., in 14 patients (16.09%) by gram-negative bacteria, while in 14 patients (16.09%) no pathogen could be identified. In 19 patients (21,84%) the infection was polymicrobial. Two patients had a superimposed Candida spp.
Methicillin-resistant S. epidermidis was found in 25 cases (28,74%), while methicillin-resistant S. aureus was isolated in only three cases (3,45%). The average hospital stay for monomicrobial infections was 29.93 ± 13.69 days and for polymicrobial infections was 37.47 ± 19.18 (p = 0.03). Wound swabs and tissue biopsies were routinely harvested for microbiological examination. The increasing number of biopsies was associated with the isolation of a pathogen (4.24 ± 2.22 vs. 2.18 ± 1.6, p < 0,001). Likewise, the increasing number of wound swabs was also associated with the isolation of a pathogen (4.22 ± 3.34 vs. 2.40 ± 1.45, p = 0.011). The median duration of antibiotic treatment was 24.62 (4-90) days intravenous and 23.54 (4-70) days orally. The length of antibiotic treatment for monomicrobial infections was 22.68 ± 14.27 days intravenous and 44.75 ± 25.87 days in total and for polymicrobial infections was 31.65 ± 22.29 days intravenous (p = 0.05) and 61.29 ± 41.45 in total (p = 0.07). The antibiotic treatment duration in patients with methicillin-resistant Staphylococci as well as in patients who developed an infection relapse was not significantly longer.
S. epidermidis and S. aureus remain the main pathogen in deep sternal wound infections. The number of wound swabs and tissue biopsies correlates with accurate pathogen isolation. With radical surgical treatment, the role of prolonged antibiotic treatment remains unclear and should be evaluated in future prospective randomized studies.
深部胸骨伤口感染是正中开胸术的一种罕见但可怕的并发症，通常由来自患者皮肤或黏膜、外部环境或医源性操作的微生物引起。最常见的病原体包括金黄色葡萄球菌、表皮葡萄球菌和革兰氏阴性菌。我们旨在评估我院深部胸骨伤口感染的微生物谱，并建立诊断和治疗方案。
我们回顾性评估了我院 2018 年 3 月至 2021 年 12 月期间发生深部胸骨伤口感染的患者。纳入标准为存在深部胸骨伤口感染和完全胸骨骨髓炎。共有 87 例患者符合研究标准。所有患者均接受根治性胸骨切除术，并进行了彻底的微生物学和组织病理学分析。
20 例（23%）感染由表皮葡萄球菌引起，17 例（19.54%）由金黄色葡萄球菌引起，3 例（3.45%）由肠球菌属引起，14 例（16.09%）由革兰氏阴性菌引起，14 例（16.09%）未检出病原体。19 例（21.84%）感染为混合感染。2 例患者合并念珠菌属感染。耐甲氧西林表皮葡萄球菌在 25 例（28.74%）中被发现，而耐甲氧西林金黄色葡萄球菌仅在 3 例（3.45%）中被分离出来。单一感染的平均住院时间为 29.93±13.69 天，混合感染的平均住院时间为 37.47±19.18 天（p=0.03）。常规采集伤口拭子和组织活检进行微生物学检查。活检的次数增加与病原体的分离相关（4.24±2.22 与 2.18±1.6，p<0.001）。同样，伤口拭子的数量增加也与病原体的分离相关（4.22±3.34 与 2.40±1.45，p=0.011）。抗生素治疗的中位持续时间为 24.62（4-90）天静脉和 23.54（4-70）天口服。单一感染的抗生素治疗时间为 22.68±14.27 天静脉和 44.75±25.87 天总疗程，混合感染的抗生素治疗时间为 31.65±22.29 天静脉（p=0.05）和 61.29±41.45 天总疗程（p=0.07）。耐甲氧西林葡萄球菌感染和感染复发患者的抗生素治疗时间无明显延长。
表皮葡萄球菌和金黄色葡萄球菌仍然是深部胸骨伤口感染的主要病原体。伤口拭子和组织活检的数量与准确的病原体分离相关。采用根治性外科治疗，延长抗生素治疗的作用仍不明确，应在未来的前瞻性随机研究中进行评估。
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