Three weeks after coronary artery bypass graft (CABG) surgery, a 52-year-old woman complained of pain at the sternal scar. The patient had a history of diabetes and hypertension. She had smoked cigarettes for many years. Blood pressure was 140/80 mm Hg; pulse rate, 96 beats per minute; and respiration rate, 20 breaths per minute. The midline scar on the chest terminated in a gaping wound at the lower part of the sternum; yellowish discharge was present. The surrounding area was erythematous and tender. Findings from neck and lung examinations were unremarkable. A loud aortic component of the second heart sound was audible; findings from the rest of the cardiac examination were unremarkable. The chest film showed no infiltrate or effusions. The echocardiogram revealed no vegetations. Postsurgical sternal wound infection was diagnosed. A culture of material from the wound grew Staphylococcus aureus. The patient was admitted to the hospital; intravenous vancomycin therapy was initiated, and insulin was administered to maintain tight glycemic control. The infection resolved within a few weeks, and the patient was discharged Major infections of sternal wounds after CABG surgery do not occur frequently; however, they are associated with substantial morbidity and mortality. Risk factors for these infections include elevated blood glucose levels during the intraoperative and postoperative periods, postoperative low cardiac output, reoperation for bleeding, rewiring of the sternum, prolonged postoperative stay in the ICU, prolonged postoperative mechanical ventilation, and a lengthy CABG procedure.1 To reduce the risk of sternal wound infection in post-CABG patients who have diabetes, closely monitor glucose levels and maintain tight glycemic control.2
1.Wang FD, Chang CH. Risk factors of deep sternal wound infections in coronary artery bypass graft surgery. J Cardiovasc Surg (Torino). 2000; 41:709-713.
2. Spelman DW, Russo P, Harrington G, et al. Risk factors for surgical wound infection and bacteraemia following coronary artery bypass surgery. Aust N Z J Surg. 2000;70:47-51.
(Case and photograph courtesy of Drs Sonia Arunabh and K. Rauhilla.)