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Sternectomy for Candida albicans sternal osteomyelitis after left ventricular assist device implantation
Authors:Mathias Van Hemelrijck  Michelle Frank  Annelies S. Zinkernagel  Ronny Buechel  Juri Sromicki  Markus J. Wilhelm  Holger Klein  Barbara Hasse  Carlos A. Mestres
Abstract:Fungal osteomyelitis is an uncommon complication after cardiac surgery and associated with high mortality. A case of Candida albicans and Staphylococcus epidermidis osteomyelitis with device infection after implantation of a left ventricular assist device in a 60-year-old male patient is presented here. After clinical identification and confirmation with microbiological examinations and fluorodeoxyglucose positron emission tomography (FDG-PET) scan, debridement was performed. Surgical specimens grew C. albicans and S. epidermidis. Fluconazole, daptomycin, and negative pressure wound therapy were initiated, but failed to achieve healing. Total sternectomy and pectoralis flap reconstruction were performed. There was no recurrent infection for C. albicans on a prolonged antifungal regime. The combination of antifungal therapy and aggressive surgical debridement may be useful to control fungal osteomyelitis.
Keywords:Left ventricular assist device   Endocarditis   Sternectomy   Fungal osteomyelitis
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