Treatment of Candida sternal infection following cardiac surgery – a review of literature. Issue 1 (2nd January 2019)

• Record Type: Journal Article
• Authors: Arıkan, Ali Ahmet; Omay, Oğuz; Kanko, Muhip; Horuz, Emre; Yağlı, Gökhan; Kağan, Emrah Yaşar; Ağır, Hakan
• Is Part Of: Infectious diseases. Volume 51:Issue 1(2019)
• Page Start: 1
• Page End: 11
• Publication Date: 2019-01-02
• Subjects: Candida -- Mediastinitis -- Sternal wound infection -- Sternal osteomyelitis -- Cardiac surgery; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1080/23744235.2018.1518583
• Languages: English
• ISSNs: 2374-4235

Abstract

Abstract: Background: Candida sternal wound infections (SWIs) following cardiac surgery are rare but are associated with a high mortality rate. Guidelines on this topic either propose no suggestions for management or offer recommendations based on a small number of reports. Methods: This paper presents a case of a Candida SWI and its successful treatment with debridement using a burr, negative pressure vacuum therapy (NPVT) and dermal grafting. To investigate different methods of treating Candida SWIs following cardiac surgery, a review was completed using the MEDLINE database. Reports without English abstracts and without defined outcomes of therapy for individual patients were excluded. Results: Seventy-seven cases of Candida SWIs following cardiac surgery were identified in 20 articles published since 1999, including our case. Treatment strategies are identified: omentum flap; muscle flap; debridement and secondary wound healing with or without NPVT; debridement and primary closure; incision and drainage; only medical therapy. Patients documented in the articles were classified based on the following outcomes: cured ( n = 41 patients [including the present case]), relapse infection ( n = 25 patients) and death ( n = 11 patients). The various methods used to treat patients were analysed. Conclusions: Delayed closure reoperation with surgical debridement and NPVT have favourable outcomes. In the presence of widespread osteomyelitis, the use of omental flaps is advocated. Treatment with muscle flaps has a high rate of relapse. Debridement and secondary healing or conservative management with antifungals alone can be considered in the treatment of relapsing infection.