sternal osteomyelitis Flashcards
sternal Osteomyelitis
Deep sternal wound infection
low incidence
primary after sternal surgery
exogenous organisms
- sternal trauma, sternal fracture, and manebriosternal septic arthritis
rarely caused by hematogenous seeding
risk factors:
HX of DM obesity , CRF , HIV , ETOH abuse, liver cirrhosis
- radiotherapy
- cardiopulmonary rescucitation
- emergency surgery
- bilateral internal mamary use
- Re- exploration
sternal osteomyelitis organisms
Causative:
staphylococcus aureus ( 10=20%)
- most common hematogenous
coagulase-negative staphylococci ( 40-60%)
- sternal wire infection
gram negative - bacilli ( 15-25%)
cutibacterium acnes ( formerly P acnes) 2-10%
Fungal infections:
Candida spp.
Pseudomonas aeruginosa
- IVDA
Salmonella spp.
Sickle cell anemia
M. tuberculosis
- endemic areas or previously infected
Polymicrobial infections:
20% of cases
indicative of exogenous supeinfection
clinical findings of sternal osteomyelitis
signs and symptoms
- fever, increased local pain, erythema
- wound discharge and sternal instability
Complications:
contigous mediastinitis
high mortality
life-threatening condition
inflammation of mediastinal structures
physiologic compromise
bleeding and sepsis
sternal osteomyelitis diagnosis
Lab:
CBC, BMP, ESR and CRP, Blood cultures
tissue sampling needed
Three samples are needed:
deep biopsies
differentiate between colonization and infection
superficial swabs
nondiagnostic and misleading
Imaging:
MRI
gold standard ++++++
detection of osteomyelitis
sternal osteomyelitis treatment plan
Antibiotic plan :
-direct treatment of staphylococci spp
- nafcillin plus rifampin
-consider local susceptible pattern
centers with MRSA
add vancomycin or daptomycin
narrow antibiotics with confirmed pathogens
Duration of therapy:
without hardware 6 weeks
sternal wire infection 3 months
surgical plan
primary sternal osteomyelitis
- treated without surgery
secondary sternal osteomyelitis
