Mediastinitis Following Open-Heart Surgery

Median sternotomy incision was routinely employed for 1,042 open-heart operations over a two-year period. Seventeen patients developed mediastinitis; seven died. Recognition of mediastinitis depended on sternal wound drainage or sternal dehiscence. Two patients withCandida albicansmediastinitis developed neither unstable sternum nor draining wound, and both died. Therapy in 15 patients consisted of mediastinum debridement followed by continuous irrigation of the closed wound with antibiotic solutions. Five of the 15 patients died. Mediastinum irrigation, usually with neomycin sulfate-bacitracin, resulted inC albicansovergrowth in six patients.Candida albicanswas directly implicated in four patients' deaths and the development of chronic chondritis in three others. Early debridement of the mediastinum upon the initial appearance of a draining, purulent sternal infection followed by continuous irrigation of the mediastinum by broad-spectrum antibiotic solution and specific systemic antibiotic therapy is the recommended therapy for postoperative mediastinal infection. The survival of ten patients out of 15 so treated strongly recommends this approach.