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Ann Thorac Surg 1976;21:442-444
© 1976 The Society of Thoracic Surgeons

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Articles

Sternal Osteomyelitis and Mediastinitis after Open-Heart Operation: Pathogenesis and Prevention

From the Hospital Infections Branch, Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, and the Division of Thoracic Surgery and Department of Medicine, Emory University Hospital, Atlanta, GA.

Accepted for publication September 16, 1975.

^* Address reprint requests to Dr. Weinstein, Hospital Infections Branch, Bureau of Epidemiology, Center for Disease Control, Atlanta, GA 30333.

Sternal osteomyelitis and mediastinitis caused by Pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patient for occult infections, on judicious selection of prophylactic antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.

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