Sternal osteomyelitis complicating median sternotomy in adults

Sternal wound infections following median sternotomy can be classified as superficial (above the fascial layer) or deep (below the fascial layer). Deep infections can be further subclassified into deep incisional infection, sternal osteomyelitis (bone involvement) and mediastinitis (involvement of retrosternal tissue)Phoon, 2020.

The most common organisms involved are Staphylococcus aureus and coagulase-negative staphylococci. Gram-negative bacteria may also be involved and these infections are often polymicrobialPhoon, 2020.

Treatment of sternal osteomyelitis complicating median sternotomy can be difficult and surgical intervention, with removal of involved wires, may be required – seek expert advice.

For adults who have signs or symptoms of sepsis or septic shock, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after taking blood samples for culture. Collect tissue samples as soon as possible; however, do not delay antibiotic administration to do so. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.

For adults who do not have sepsis or septic shock, collect blood and tissue samples for culture and susceptibility testing before starting antibiotic therapy. For antibiotic management while awaiting the results of culture and susceptibility, see Empirical therapy for deep incisional surgical site infection or surgical site infection with systemic features.

The optimal duration of antibiotic therapy is uncertain, but 6 weeks of therapy (intravenous + oral) should be sufficient in most cases.