Grossi et al described the clinical findings associated with major infections of median sternotomy wounds. Early diagnosis and treatment is important for successful management. The authors are from New York University Medical Center.
Local findings associated with the sternal wound:
(1) drainage from chest wound and/or chest tube
(2) increased pain
(3) erythema about the sternal wound
(4) instability of the sternal wound (including palpable "rocking" on coughing)
(5) demonstration of mediastinal fluid collection on an imaging study
Systemic findings:
(1) fever > 38.64°C (> 101.5°F)
(2) leukocytosis > 12,000 per µL
(3) positive blood culture
Some patients were difficult to diagnose, with the sternal wound appearance unremarkable. In these patients multiple retrosternal aspirations were able to isolate a pathogen.
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