Transposition of Greater Omentum in Deep Sternal Wound Infection Caused by Methicillin-Resistant Staphylococci, with Differing Clinical Course for MRSA and MRSE

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) are an increasing problem in deep sternal wound infections (DSWI) after cardiac surgery. Methods: Between 2005 and 2009, recalcitrant methicillin-resistant Staphylococcus was found in 21 patients with complicated DSWI, and a transposition of the greater omentum (TGO) was finally performed. A positive microbial culture at the time of procedure was present in all patients. The hospital course was reviewed discretely for MRSA and MRSE. Results: Median patient age was 72.3 years (range 60.8-79.7); 76% of patients were male. Time from the first sternal revision until consecutive open wound therapy due to re-infection and total hospital stay was longer for MRSA compared to MRSE (38 vs. 14 days, p = 0.003, and 141 vs. 91 days, p = 0.007, respectively). The period from cardiac surgery to TGO was likewise prolonged for MRSA (78 vs. 55 days, p = 0.045), whereas in-hospital mortality and one-year mortality rate did not differ. Conclusion: TGO remains a good treatment option for DSWI type IV. Microbial findings determine the clinical course; nevertheless in-hospital mortality remains low for both MRSA and MRSE infection.