Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 4, 2015; 4(4): 265-273
Published online Nov 4, 2015. doi: 10.5492/wjccm.v4.i4.265
Deep sternal wound infection after cardiac surgery: Evidences and controversies
Paolo Cotogni, Cristina Barbero, Mauro Rinaldi
Paolo Cotogni, Anesthesiology and Intensive Care, Department of Medicine, S. Giovanni Battista Hospital, University of Turin, 10123 Turin, Italy
Cristina Barbero, Mauro Rinaldi, Department of Cardiovascular and Thoracic Surgery, S. Giovanni Battista Hospital, University of Turin, 10123 Turin, Italy
Author contributions: Cotogni P and Barbero C developed the research question and review design, drafted and finalized the manuscript; Rinaldi M revised it critically for important intellectual content; all authors approved the final version.
Conflict-of-interest statement: The authors have no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paolo Cotogni, MD, MSc, Anesthesiology and Intensive Care, Department of Medicine, S. Giovanni Battista Hospital, University of Turin, Via Giovanni Giolitti 9, 10123 Turin, Italy. paolo.cotogni@unito.it
Telephone: +39-11-5171634 Fax: +39-11-6334324
Received: May 30, 2015
Peer-review started: May 30, 2015
First decision: August 14, 2015
Revised: September 18, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 4, 2015
Processing time: 160 Days and 14.9 Hours
Abstract

Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid- and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at high-risk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a “bridge” prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors - when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate.

Keywords: Risk factors; Sternotomy; Wound healing; Wound infection; Postoperative care

Core tip: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections due to increasing length of stay, costs, and mortality. In particular, deep sternal wound infection (DSWI) is a worrying complication after cardiac surgery, with a still relevant incidence. Unfortunately, DWSI appearance is related to a wide number of both patient and surgical factors. This review may be useful for guiding physicians to the knowledge of main risk factors and the choice of the appropriate management of DWSIs with the aim of reducing the rate of this potentially devastating complication in cardiac surgery patients.