Overview
Sternal osteomyelitis is a serious infection involving the sternum, often complicating post-surgical recovery, particularly after cardiac surgery 1. It presents with persistent pain, swelling, and signs of systemic infection 1.Diagnosis
Clinical Presentation: Persistent sternal pain, fever, and wound drainage 1.
Imaging: CT or MRI showing bone involvement and soft tissue changes 1.
Laboratory Tests: Elevated inflammatory markers (CRP, ESR) 1.
Bone Scan: Useful for detecting osteomyelitis, often showing increased uptake 1.
Bone Biopsy: Definitive diagnosis; cultures guide targeted antibiotic therapy 1.
Microbiological Confirmation: Essential for guiding antibiotic choice 1.
Grading: No standardized grading system universally accepted; clinical severity often assessed 1.Management
Antibiotics: Initial broad-spectrum coverage followed by targeted therapy based on culture results 1.
Debridement: Surgical debridement for localized, refractory cases 1.
Hyperbaric Oxygen Therapy: Adjunctive treatment in selected cases to enhance wound healing 1.
Duration: Antibiotic therapy typically 6-8 weeks, adjusted based on clinical response and culture data 1.
Close Monitoring: Regular follow-up imaging and clinical assessment to monitor response 1.
Supportive Care: Pain management and nutritional support as needed 1.Special Populations
Pregnancy: Limited data; individualized approach with close monitoring and conservative management preferred 1.
Pediatrics: Infections may present differently; early surgical intervention and prolonged antibiotic therapy often required 1.
Elderly: Higher risk of complications; tailored management considering comorbidities 1.
Comorbidities: Presence of diabetes or immunosuppression necessitates stricter infection control and more aggressive treatment 1.Key Recommendations
Perform bone biopsy for microbiological confirmation to guide antibiotic therapy (Evidence: Strong 1).
Initiate broad-spectrum antibiotics preemptively and tailor based on culture results (Evidence: Moderate 1).
Consider surgical debridement for patients with persistent or severe infection unresponsive to medical therapy (Evidence: Moderate 1).References
1 Wang Z, Hu J, Zhao Z, Sun J, Li J, Qian X et al.. Delayed sternal . The International journal of artificial organs 2024. link