Læknablaðið - apr 2019, Qupperneq 30

182 LÆKNAblaðið 2019/105
Tómas Guðbjartsson1,3
Anders Jeppsson2
Wound infections are common complications after open heart sur-
gery, both in the sternotomy and vein harvest wound. Fortunately,
most of these infections are superficial and respond to minor wound
debridement and antibiotics, however, 1-3% of patients develop
deep sternal wound infection with mediastinis; an infection that can
be fatal. Late infections with sternocutaneous fistulas are encoun-
tered less often, but also represent a complex surgical
problem. The vein harvest site is the most common site for wound
infections after cardiac surgery and these infections result in signifi-
cant patient morbidity and increases health-care costs.
This evidence-based review covers etiology, risk factors, preven-
tion and treatment of wound infections following open heart surgery
with special focus on advances in treatment, especially negative-
pressure wound therapy.
Wound infections following open heart surgery - review
ENGLISH SUMMARY
1Department of Cardiothoracic Surgery, Landspitali University Hospital, 2Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, 3Faculty of Medicine, Uni-
versity of Iceland.
Key words: Wound infections, Cardiac surgery, Deep sternal wound infection, treatment, negative pressure wound therapy.
Correspondence: Tómas Guðbjartsson, tomasgudbjartsson@hotmail.com
21. Hallgrímsdóttir H, Gottfreðsson M, Guðbjartsson T.
Framsýn rannsókn á skurðsýkingum eftir 246 opnar
hjartaaðgerðir (E200). Læknablaðið (Fylgirit 66) 2011; 97.
22. Exarhos DN, Malagari K, Tsatalou EG, Benakis SV, Peppas
C, Kotandidou A, et al. Acute mediastinitis: spectrum
of computed tomography findings. Eur Radiol 2005; 15:
1569-74.
23. Steingrimsson S, Gottfredsson M, Kristinsson KG,
Gudbjartsson T. Deep sternal wound infections following
open heart surgery in Iceland: a population-based study.
Scand Cardiovasc J 2008; 42: 208-13.
24. Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully
HE, et al. Deep sternal wound infection: risk factors and
outcomes. Ann Thorac Surg 1998; 65: 1050-6.
25. Sjögren J, Gustafsson R, Nilsson J, Malmsjö M,
Ingemansson R. Clinical outcome after poststernotomy
mediastinitis: vacuum-assisted closure versus con-
ventional treatment. Ann Thorac Surg 2005; 79: 2049-55.
26. Dai C, Lu Z, Zhu H, Xue S, Lian F. Bilateral internal
mammary artery grafting and risk of sternal wound infect-
ion: evidence from observational studies. Ann Thorac
Surg 2013; 95: 1938-45.
27. Itagaki S, Cavallaro P, Adams DH, Chikwe J. Bilateral
internal mammary artery grafts, mortality and morbidity:
an analysis of 1 526 360 coronary bypass operations. Heart
2013; 99: 849-53.
28. Kajimoto K, Yamamoto T, Amano A. Coronary artery
bypass revascularization using bilateral internal thoracic
arteries in diabetic patients: a systematic review and meta-
analysis. Ann Thorac Surg 2015; 99: 1097-104.
29. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A.
Continuous intravenous insulin infusion reduces the
incidence of deep sternal wound infection in diabetic pati-
ents after cardiac surgical procedures. Ann Thorac Surg
1999; 67: 352-60; discussion 60-2.
30. Dodds Ashley ES, Carroll DN, Engemann JJ, Harris
AD, Fowler VG jr, Sexton DJ, et al. Risk factors for
postoperative mediastinitis due to methicillin-resistant
Staphylococcus aureus. Clin Infect Dis 2004; 38:1 555-60.
31. Steingrimsson S, Gottfredsson M, Gudmundsdottir I,
Sjögren J, Gudbjartsson T. Negative-pressure wound
therapy for deep sternal wound infections reduces the rate
of surgical interventions for early re-infections. Interact
Cardiovasc Thorac Surg 2012; 15: 406-10.
32. European Antimicrobial Resistance Surveillance Network
(EARS-Net). ecdc.europa.eu/en/healthtopics/antimicrobi-
al_resistance/database/Pages/map_reports.aspx - janúar
2019.
33. Bryant LR, Spencer FC, Trinkle JK. Treatment of median
sternotomy infection by mediastinal irrigation with an
antibiotic solution. Ann Surg 1969; 169: 914-20.
34. Petzina R, Hoffmann J, Navasardyan A, Malmsjö M,
Stamm C, Unbehaun A, et al. Negative pressure wound
therapy for post-sternotomy mediastinitis reduces morta-
lity rate and sternal re-infection rate compared to con-
ventional treatment. Eur J Cardiothorac Surg 2010; 38:
110-3.
35. Sjögren J, Nilsson J, Gustafsson R, Malmsjö M,
Ingemansson R. The impact of vacuum-assisted closure
on long-term survival after post-sternotomy mediastinitis.
Ann Thorac Surg 2005; 80: 1270-5.
36. Guðmundsdóttir I, Steingrímsson S, Valsdóttir
E, Guðbjartsson T. Sárasogsmeðferð - yfirlitsgrein.
Læknablaðið 2014; 100: 219-24.
37. Glass GE, Murphy GF, Esmaeili A, Lai LM, Nanchahal J.
Systematic review of molecular mechanism of action of
negative-pressure wound therapy. Brit J Surg 2014; 101:
1627-36.
38. Wackenfors A, Gustafsson R, Sjögren J, Algotsson L,
Ingemansson R, Malmsjö M. Blood flow responses in the
peristernal thoracic wall during vacuum-assisted closure
therapy. Ann Thorac Surg 2005; 79: 1724-30; discussion
30-1.
39. Malmsjö M, Gustafsson L, Lindstedt S, Gesslein B,
Ingemansson R. The effects of variable, intermittent, and
continuous negative pressure wound therapy, using
foam or gauze, on wound contraction, granulation tissue
formation, and ingrowth into the wound filler. Eplasty
2012; 12: e5.
40. Mokhtari A, Petzina R, Gustafsson L, Sjögren J, Malmsjö
M, Ingemansson R. Sternal stability at different negative
pressures during vacuum-assisted closure therapy. Ann
Thorac Surg 2006; 82: 1063-7.
41. Borgquist O, Ingemansson R, Malmsjö M. The influence
of low and high pressure levels during negative-pressure
wound therapy on wound contraction and fluid evacu-
ation. Plast Reconstr Surg 2011; 127: 551-9.
42. Gudbjartsson T, Sigurdsson HK, Sigurdsson E, Kjartansson
J. Vacuum-Assisted Closure for Successful Treatment of a
Major Contaminated Gunshot Chest-Wound: A Case
Report. Eur J Trauma Emerg Surg 2008; 34: 508.
43. Gustafsson R, Johnsson P, Algotsson L, Blomquist S,
Ingemansson R. Vacuum-assisted closure therapy guided
by C-reactive protein level in patients with deep sternal
wound infection. J Thorac Cardiovasc Surg2002; 123: 895-
900.
44. Sjögren J, Gustafsson R, Nilsson J, Lindstedt S, Nozohoor
S, Ingemansson R. Negative-pressure wound therapy
following cardiac surgery: bleeding complications and
30-day mortality in 176 patients with deep sternal wound
infection. Interact Cardiovasc Thorac Surg 2011; 12: 117-
20.
45. Gustafsson RI, Sjögren J, Ingemansson R. Deep sternal
wound infection: a sternal-sparing technique with
vacuum-assisted closure therapy. Ann Thorac Surg 2003;
76: 2048-53; discussion 53.
46. Baillot R, Cloutier D, Montalin L, Coté L, Lellouche F,
Houde C, et al. Impact of deep sternal wound infection
management with vacuum-assisted closure therapy foll-
owed by sternal osteosynthesis: a 15-year review of 23,499
sternotomies. Eur J Cardiothorac Surg 2010; 37: 880-7.
47. Tarzia V, Carrozzini M, Bortolussi G, Buratto E, Bejko
J, Comissio M et al. Impact of vacuum-assisted closure
therapy on outcomes of sternal wound dehiscencedagger.
Interact Cardiovasc Thorac Surg 2014; 19: 70-5.
48. Petursdottir A, Gudbjartsson T. Deep wound infections in
Iceland 1996-2018. In submission (verður lagfært)
49. Jideus L, Liss A, Stahle E. Patients with sternal wound
infection after cardiac surgery do not improve their
quality of life. Scand Cardiovasc J 2009; 43: 194-200.
50. Graf K, Ott E, Vonberg RP, Kuehn C, Haverich A,
Chaberny IF. Economic aspects of deep sternal wound
infections. Eur J Cardiothorac Surg 2010; 37: 893-6.
51. Braxton JH, Marrin CA, McGrath PD, Morton JR,
Norotsky M, Charlesworth DC, et al. 10-year follow-up
of patients with and without mediastinitis. Semin Thorac
Cardiovasc Surg 2004; 16: 70-6.
52. Sarr MG, Gott VL, Townsend TR. Mediastinal infection
after cardiac surgery. Ann Thorac Surg 1984; 38: 415-23.
53. Sjögren J, Malmsjö M, Gustafsson R, Ingemansson R.
Poststernotomy mediastinitis: a review of conventional
surgical treatments, vacuum-assisted closure therapy and
presentation of the Lund University Hospital mediastinit-
is algorithm. Eur J Cardiothorac Surg 2006; 30: 898-905.
54. Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A
systematic review of topical negative pressure therapy for
acute and chronic wounds. Brit J Surg 2008; 95: 685-92.
55. Peinemann F, McGauran N, Sauerland S, Lange S.
Negative pressure wound therapy: potential publication
bias caused by lack of access to unpublished study results
data. BMC Med Res Methodol 2008; 8: 4.
56. Mokhtari A, Sjögren J, Nilsson J, Gustafsson R, Malmsjö
M, Ingemansson R. The cost of vacuum-assisted closure
therapy in treatment of deep sternal wound infection.
Scand Cardiovasc J 2008; 42: 85-9.
57. Tocco MP, Ballardini M, Masala M, Perozzi A. Post-
sternotomy chronic osteomyelitis: is sternal resection
always necessary? Eur J Cardiothorac Surg 2013; 43: 715-
21.
58. Jones G, Jurkiewicz MJ, Bostwick J, Wood R, Bried JT,
Culbertson J, et al. Management of the infected median
sternotomy wound with muscle flaps. The Emory 20-year
experience. Ann Surg 1997; 225: 766-76; discussion 76-8.
59. Vestergaard RF, Jensen H, Vind-Kezunovic S, Jakobsen
T, Soballe K, Hasenkam JM. Bone healing after median
sternotomy: a comparison of two hemostatic devices. J
Cardiothorac Surg 2010; 5: 117.
60. Bakaeen FG, Zenati MA, Bhatt DL. Conduits in coronary
artery bypass grafting. Semin Thorac Cardiovasc Surg
2013; 25: 273-9.
Heimildir 61-80 eru á heimasíðu blaðsins.
Barst til blaðsins 29. desember 2018,
samþykkt til birtingar 12. mars 2019.
Y F I R L I T S G R E I N