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J Thorac Cardiovasc Surg 2003;125:611-617
© 2003 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Sternal puncture allows an early diagnosis of poststernotomy mediastinitis

Sidney Benlolo, MDa, Joaquim Matéo, MDa, Laurent Raskine, MDb, Omar Tibourtine, MDa, Alain Bel, MDc, Didier Payen, MD, PhDa, Alexandre Mebazaa, MD, PhDa

From the Department of Anesthesiology and Critical Care Medicinea; Service de Bactériologie et de Virologie,b Institut Fédératif de Recherches Circulation, Hôpital Lariboisière; Service de Chirurgie Cardio-Vasculaire B,c Hôpital Bichat-Claude Bernard; Assistance Publique—Hôpitaux de Paris, France.

This study was supported by a grant from Ministère Français de l'Enseignement Supérieur et de la Recherche.

Received for publication Jan 25, 2002. Revisions requested April 8, 2002; revisions received June 25, 2002. Accepted for publication July 2, 2002. Address for reprints: Alexandre Mebazaa, MD, PhD, Département d'Anesthésie-Réanimation-SMUR, Hôpital Lariboisière, 2 rue Ambroise-Paré, 75475 Paris Cedex 10, France (E-mail: alexandre.mebazaa{at}lrb.ap-hop-paris.fr).

Objectives: Poststernotomy mediastinitis after cardiac operations is a nosocomial infection involving the mediastinal space and the sternum, with a high mortality rate mostly related to a late diagnosis. We investigated whether sternal puncture might facilitate and shorten the delay in the diagnosis of mediastinitis.
Methods: Of 1024 patients undergoing sternotomy for cardiac surgery, sternal puncture was performed in a subgroup of 49 patients in whom mediastinitis was suspected.
Results: Sternal puncture culture results were positive for all patients with true mediastinitis (n = 23) and negative in 24 of 26 patients without mediastinitis. In addition, sternal puncture allowed diagnosis of mediastinitis with a shorter delay (9 ± 5 days vs 13 ± 8 days, P = .04) and caused a reduction in the length of mechanical ventilation (3 ± 4 days vs 10 ± 13 days, P = .02) and stay in the intensive care unit (9 ± 7 days vs 18 ± 15 days, P = .02) compared with that found in another group of patients (n = 20) operated on for true mediastinitis on the basis of the presence of classic, delayed, clinical signs.
Conclusions: Our study shows that sternal puncture is a rapid and safe method to ensure the diagnosis of poststernotomy mediastinitis.






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