Sternal Osteomylitis

Question 1

When does sternal osteo typically occur

Answer 1

After sternal surgery, trauma, fracture

Question 2

Risk factors for sternal osteo

Answer 2

DM, Obesity, CRF, HIV, ETOH, cirrhosis, radiotherapy, CPR, emergent surgery, b/l mammary use, re-exploration

Question 3

Most common organism in sternal osteo

Answer 3

Staph aureus

Question 4

All infectious causes of sternal osteo

Answer 4

1. Staph aureus
2. Coag neg staph (with wire surgeries)
3. Gram negative bacilli
4. C. Acnes
5. Fungal
   6.IVDA pseudomonas
   7.Salmonella in SS
6. TB
7. Poly microbial

Question 5

S/S of sternal osteo

Answer 5

Fever, increased local pain, erythema, wounds discharge, sternal instability

Question 6

Complications of sternal Osteo

Answer 6

High morbidity, physiologic compromise, bleeding, sepsis

Question 7

Diagnostics for sternal osteo (including labs, cx, and imaging)

Answer 7

Labs: CBC, CMP, ESR, CRP, BCx, Wound Cx
Imaging: MRI GOLD STANDARD

Question 8

ABX regimen for sternal osteo

Answer 8

Staph- naficillin plus rifampin.
MRSA-Vanco or daptomycin

Question 9

ABX duration of therapy in sternal osteo

Answer 9

W.o hardware: 6 weeks
W hardware: 3 months

Question 10

Surgical interventions for sternal osteo

Answer 10

Primary: no surgery
Secondary: debridement