this ppt is made to discuss certain specific journal

1. JOURNAL READING
Deep Sternal Wound Infection
After Open-heart Cardiac Surgery and
Vacuum-Assisted Closure Therapy:
a Single-center Study
Oleh:
Chandra Wijaya Setiawan
2271181002
Pembimbing :
dr. I KOMANG ADHI PARAMA HARTA, Sp.BTKV, Subsp.JD(K)

3. BACKGROUND
• Despite advance technology & prevention, cardiac
surgery with median sternotomy have a significant
risk of sternal wound infection (SSWI 0.5-8% ,
DSWI 0.5-6.8%)
• Mortality: SSWI 0.5-9% , DSWI 7-47%
• DSWI ↓mid &long-term survival, ↑hospital stay &
↑hospital costs.
• Due to complex situations & difficulties in
diagnosis & management, it requires
multidisciplinary team (cardiothoracic surgeons,
plastic surgeons, intensivists, infectious disease
specialists & clinical microbiologists)

4. RISK FACTORS
• Patient-related
Age, ♀, obesity, DM, smoking, alcoholism,
malignancy, steroids, comorbidities, S.aureus nasal,
skin infection, osteoporosis, chronic infections (HIV,
Hep B&C/ bacterial infection >4 weeks/on
antibiotics at surgery), emergent/urgent surgery.
• Intraoperative
CABG with valve / aortic surgery, long operation
time, bilateral use of internal mammary arteries
• Postoperative
Prolonged ventilator support & inotropic support,
bleeding re-exploration, postoperative blood
transfusion)

5. Classification
Classification of mediastinitis according to El Oakley and Wright based on the number of
risk factors & time to presentation after surgery

6. Vacuum-Assisted Closure (VAC)
• Promotes wound healing through negative
pressure, especially in infected tissues.
• VAC improve DSWI healing by ↑ blood flow,
↓bacterial loads & ↑ granulation.

7. OBJECTIVES
Incidences
Risk factors
Identify microbiology findings
Antibiotic therapy

8. METHODS
• Retrospective observational study, Clinic for
Cardiovascular Surgery at University Clinical
Center Sarajevo (November 2015 – 2020).
• 15 patients DSWI following open-heart surgery.
• Inclusion criteria: DSWI after cardiac operation
via median sternotomy, & complete results of
microbiological findings obtained by sternal
swab.
• Exclusion criteria: Patients with incomplete
clinical data.

9.  The non-VAC group (n=8), was treated
conventionally (surgical debridement, sternum
fixation & retrosternal irrigation)
 VAC group (n=7) treatment consisted of
surgical debridement, open sternum with VAC
therapypectoral flap+sternum refixation.

10. RESULTS

13. 0.4% - 2.3% 1% discrepancy is the result of the
sample size
♀ ♂ (60%) -
Obesity, DM, etc. Obesity & DM Match with other studies
Staphylococcus aureus & S.
epidermidis (most common).
E. coli, Enterobacter spp,
Pseudomonas aeruginosa, β-
hemolytic streptococci, S. Aureus ,
MSSA.
Enterococcus faecalis (27%).
Klebsiella pneumonia (13%), Proteus
mirabilis (9%), MRSA (9%) & Serratia
marecens (9%)
-
Not mentioned Cefazolin 2gr (Prophylaxis)
Cefazolin 3x1gr
+ Vancomycin 2x1gr
microbiological isolates &
antibiogram 2 antibiotics
(Vancomycin +Imipenem)
12 14% - 25% 33.4%. Non-VAC group 3 & VAC
group 2
Patients † have several comorbidities
& came from their homes, ±15 days
after discharge from the hospital
DISCUSSION

14. CONCLUSION
Despite preventive procedures & treatment of
DSWI high incidence & mortality rate.
VAC therapy in DSWI, showed good results small
number of patients need more samples.
VAC improve DSWI healing by ↑ blood flow,
↓bacterial loads & ↑ granulation.