Treatment of Candida sternal infection following cardiac surgery - a review of literature

• Published in: Infectious diseases (London, England) Vol. 51; no. 1; pp. 1 - 11
• Main Authors: Arıkan, Ali Ahmet, Omay, Oğuz, Kanko, Muhip, Horuz, Emre, Yağlı, Gökhan, Kağan, Emrah Yaşar, Ağır, Hakan
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02-01-2019
• Subjects: Candida; Cardiac surgery; Mediastinitis; Sternal osteomyelitis; Sternal wound infection; Cardiac surgery; Sternal osteomyelitis; Mediastinitis; Sternal wound infection
• ISSN: 2374-4235; 2374-4243
• DOI: 10.1080/23744235.2018.1518583

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.