Critical Care and Shock

Post-sternotomy mediastinitis: What the intensivist needs to know

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Abstract

Deep sternal wound infection (DSWI) is a dreaded complication after cardiac surgery, which dramatically increases health costs, in addition to high morbidity and mortality. The diagnosis and treatment of post-sternotomy mediastinitis (PSM) is a professional challenge. The aim of this current narrative mini review, we will consider epidemiology, implicit risk factors, the basis of diagnosis, preoperative, intraoperative, and postoperative prevention, and antimicrobial procedures, as well as the management of an optimal antimicrobial policy including an antimicrobial switch therapy.

Antibiotic cost represents a significant part of hospital budgets all over the world and more when the cost falls directly on the patient in those health systems that do not cover assistance and treatment. The management of switch therapy is not yet well known in patients with mediastinitis and it is common to find some objection in its use due to the change from long-acting intravenous antimicrobial antibiotics to oral regimen in this type of patients, most of them with high hospitalization rates.

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