Sternal Wound Infection

March 1, 2003

Three weeks after coronary artery bypass graft (CABG)surgery, a 52-year-old woman complained of pain at thesternal scar. The patient had a history of diabetes and hypertension.She had smoked cigarettes for many years.

Three weeks after coronary artery bypass graft (CABG)surgery, a 52-year-old woman complained of pain at thesternal 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, 96beats per minute; and respiration rate, 20 breaths perminute.

The midline scar on the chest terminated in a gapingwound at the lower part of the sternum; yellowish dischargewas present. The surrounding area was erythematousand tender. Findings from neck and lung examinationswere unremarkable. A loud aortic component of thesecond heart sound was audible; findings from the rest ofthe cardiac examination were unremarkable.

The chest film showed no infiltrate or effusions. Theechocardiogram revealed no vegetations. Postsurgicalsternal wound infection was diagnosed. A culture of materialfrom the wound grew Staphylococcus aureus.

The patient was admitted to the hospital; intravenousvancomycin therapy was initiated, and insulin wasadministered to maintain tight glycemic control. The infectionresolved within a few weeks, and the patient wasdischarged.

Major infections of sternal wounds after CABG surgerydo not occur frequently; however, they are associatedwith substantial morbidity and mortality. Risk factorsfor these infections include elevatedblood glucose levels during the intraoperativeand postoperative periods,postoperative low cardiac output, reoperationfor bleeding, rewiring ofthe sternum, prolonged postoperativestay in the ICU, prolonged postoperativemechanical ventilation, and alengthy CABG procedure. 1

To reduce the risk of sternalwound infection in post-CABG patientswho have diabetes, closelymonitor glucose levels and maintaintight glycemic control.2

References:

REFERENCES:1.Wang FD, Chang CH. Risk factors of deep sternalwound infections in coronary artery bypassgraft surgery. J Cardiovasc Surg (Torino). 2000;41:709-713.
2. Spelman DW, Russo P, Harrington G, et al. Riskfactors for surgical wound infection and bacteraemiafollowing coronary artery bypass surgery. Aust N ZJ Surg. 2000;70:47-51.