Abstract
Purpose
Culture of extracted drains or epicardial pacing wires is an easy and noninvasive method for detecting mediastinitis after open-heart surgery, although studies on its sensitivity and specificity are limited. We, therefore, investigated the usefulness of this approach for diagnosing mediastinitis.
Methods
We retrospectively studied the culture results of drains and epicardial pacing wires extracted from 3308 patients. Prediction models of mediastinitis with and without culture results added to clinical risk factors identified by a logistic regression analysis were compared.
Results
The incidence of mediastinitis requiring surgery was 1.89% (n = 64). Staphylococcus was the causative bacterium in 64.0% of cases. The sensitivity, specificity, and positive and negative predictive values of positive culture results were 50.8%, 91.8%, 10.7%, and 99.0%, respectively. Methicillin-resistant Staphylococcus aureus had the highest positive predictive value (61.5%). A multivariate analysis identified preoperative hemodialysis (OR 5.40 [2.54−11.5], p < 0.01), long operative duration (p < 0.01), postoperative hemodialysis (OR 2.25 [1.01−4.98], p < 0.05), and positive culture result (OR 10.2 [5.88−17.7], p < 0.01) as independent risk factors. The addition of culture results to pre- and postoperative hemodialysis and a lengthy operative time improved the prediction of mediastinitis.
Conclusions
A culture survey using extracted drains and epicardial pacing wires may provide useful information for diagnosing mediastinitis.
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References
Abu-Omar Y, Kocher GJ, Bosco P, Barbero C, Waller D, Gudbjartsson T, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017;51:10–29.
Chello C, Lusini M, Nenna A, Nappi F, Spadaccio C, Satriano UM, et al. Deep Sternal Wound Infection (DSWI) and mediastinitis after cardiac surgery: current approaches and future trends in prevention and management. Surg Technol Int. 2020;36:212–6.
Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152:784–91.
Goh SSC. Post-sternotomy mediastinitis in the modern era. J Card Surg. 2017;32:556–66.
Kaspersen AE, Nielsen SJ, Orrason AW, Petursdottir A, Sigurdsson MI, Jeppsson A, et al. Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART. Eur J Cardiothorac Surg. 2021;60:233–41.
Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg. 2017;12:94.
Browdie DA, Bernstein RV, Agnew R, Damle A, Fischer M, Balz J. Diagnosis of poststernotomy infection: comparison of three means of assessment. Ann Thorac Surg. 1991;51:290–2.
Hastings JC 3rd, Robicsek F. Clinical significance of epicardial pacing wire cultures. J Thorac Cardiovasc Surg. 1993;105:165–7.
Maroto LC, Aguado JM, Carrascal Y, Pérez A, Pérez-de-la-Sota E, Cortina JM, et al. Role of epicardial pacing wire cultures in the diagnosis of poststernotomy mediastinitis. Clin Infect Dis. 1997;24:419–21.
Mekontso-Dessap A, Honoré S, Kirsch M, Houël R, Loisance D, Brun-Buisson C. Usefulness of routine epicardial pacing wire culture for early prediction of poststernotomy mediastinitis. J Clin Microbiol. 2004;42:5245–8.
Jung Y, Lee KS, Oh SG, Jeong Y (2022) Routine Mediastinal Drainage Fluid Culture for Early Diagnosis of Poststernotomy Mediastinitis. Thorac Cardiovasc Surg
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Kawamura, A., Yoshioka, D., Kawamura, M. et al. The usefulness of chest drain and epicardial pacing wire culture for diagnosing mediastinitis after open-heart surgery. Surg Today 54, 73–79 (2024). https://doi.org/10.1007/s00595-023-02720-x
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DOI: https://doi.org/10.1007/s00595-023-02720-x