Sternal wound tuberculosis following cardiac operations: a review

Objective

The diagnosis and treatment of sternal wound infections with mycobacteria arechallenging. Such an infection is often associated with a delayed diagnosisand improper treatment that may lead to a worsened clinical outcome. Thepresent study is designed to highlight its clinical features so as tofacilitate a prompt diagnosis and timely treatment.

Methods

MEDLINE, Highwire Press, and Google search engine were searched forpublications in the English language, with no time limit, reporting onsternal wound infection caused by tuberculosis after cardiac surgery.

Results

A total of 12 articles reporting on 14 patients were included in this study.Coronary artery bypass grafting was the underlying surgical procedure inmore than half of the cases. Purulent discharge and cold abscess were thetwo main presenting symptoms. Diagnosis of sternal wound infection wasevidenced in all 14 patients by different investigations, with culture ofsamples being the most sensitive method of identifying the pathogen. Goodresponse to first-line anti-tuberculous agents was noted. Almost allpatients required surgical debridement/resection and, sometimes, sternalreconstruction. A delayed diagnosis of sternal wound infection may lead torepeated recurrences. A comparison between patients with sternal woundinfection due to tuberculosis and non-tuberculous mycobacterial infectionsshowed that the former infections took an even longer period of time.Comparisons also revealed patients with sternal tuberculosis infection had asignificantly higher mortality than patients with sternal non-tuberculousinfection (29.2% vs. 0%, P=0.051).

Conclusion

Sternal infection caused by tuberculosis after cardiac surgery has a longerlatency, better response to first-line drugs, and better outcomes incomparison with non-tuberculous sternal infection. Early diagnosis and earlyanti-tuberculous treatment can surely improve the patients'' prognosis.