Sternal Wound Complications

Sternal wound complications vary from persistent chest pain and sternal instability to partial or complete wound dehiscence and mediastinitis. Of all sternal wound complications, mediastinitis is considered the most serious; it requires surgical treatment and prolonged antibiotic therapy and continues to have a dramatic impact on patient survival, with a reported hospital mortality rate of between 10% and 20%. Gram-positive bacteria are the most commonly isolated bacteria in mediastinitis; Staphylococcus aureus or S. epidermidis are identified in 70–80% of cases. Gram-negative bacteria and fungal infections are less common. Mixed infections may account for up to 40% of cases. Special attention should be given to bacteria which have become resistant to antibiotics that are in common use as prophylaxis, in particular the methicillinresistant Staphylococcus aureus (MRSA), or those resistant to vancomycin, vancomycin intermediate-resistant S. aureus (VISA) . In addition, mediastinitis has been found to affect long-term survival and to be an independent risk factor for late mortality in patients who have undergone CABG surgery