Microbiological screening of dehiscent sternal surgical site

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Objectives: The continuous increase in multiresistant microorganisms urged us to look into the bacterial colonization of the sternal surgical site. Its subsequent infection is a rare yet potentially devastating complication following median sternotomy. The preoperative microbiological screening and decolonisation targeting Staphylococcus Aureus (SA) is one method aimed to reduce the incidence of sternal wound infections. Methods: We analyzed retrospectively 2011 consecutive patients undergoing extracorporeal circulation assisted heart surgery procedures with regard to sternal surgical site healing disorders (SSD) and their bacterial colonization. Antibiotic therapy was routinely administered one day postop. for coronary artery bypass grafting (CABG) and three days for valve surgery, respectively. Results: We identified 94 (4.7%) patients with SSD up to the primary discharge from the hospital, 38 superficial and 56 deep SSD. 94% of the patients were screened for SA (n = 1887), 23.7% (n = 447) were SA + , 1.4% (n = 28) were Methicillin-Resistant SA + (MRSA + ) and 22.2% (n = 419) were Methicillin-Sensitive SA + (MSSA + ). Five patients (0.25%) developed MRSA + SSD. One was preop. MRSA + (3.57% of preop. MRSA + ) and one was not screened (0.80% of not screened). Three preop. MRSA - patients (0.16% of preop. MRSA - ) developed a MRSA + SSD. Eleven (0.58%) patients developed MSSA + SSD. Five was preop. MSSA + (1.19%) and three were not screened (2.40%). Three preop. MSSA - patients (0.20%) developed a MSSA + SSD. Table 1: Wound depht, procedure type and bact. colonization Wound depht, procedure and bacterial colonisation characteristics (percentage of total is given) CABG CABG plus Valve BIMA Valve surgery MRSA MSSA Coagulase negative staphylococci Gram negative bacteria Superficial 44.7 18.4 16.8 23.7 2.4 7.3 61 17.1 Deep 66.1 17.9 17.3 3.6 6.1 12.1 48.5 21.2 Conclusion: This study shows a low incidence of Staphylococcus aureus colonization in dehiscent sternal wounds. However, the revealed wound colonization bacteria suggests that local hygiene plays a determinant role. Coagulase positive staphylococci and gram negative bacteria tended to colonize more often the deep SSD whereas coagulase negative staphylococci the superficial ones. The use of bilateral internal mammary artery (BIMA) graft showed no influence in the sternal wound depth postoperatively. The majority of SSD were associated with CABG procedures. Isolated valve surgery showed the lowest incidence of deep SSD. The prolonged postoperative antibiotic therapy following valve surgery did not reduce the incidence of superficial surgical site healing disorders.

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