J Thorac Cardiovasc Surg 1998;116:374
© 1998 Mosby, Inc.
Cultures for sternal infection
Fred Kerns, MD,
Marilyn Zimmerman, SM(ASCP),
Kevin Tu, PhD
To the Editor:
The extent of laboratory culturing needed for sternal wound infection workup is variable and situation-dependent. At our hospital, many surgeons have sent anaerobic, fungal, and acid-fast cultures at the time of sternal debridement. Reports of such infections supported this practice.
1,2
Our surgeons perform more than 2000 cardiac operations each year and therefore infectious complications are seen regularly. A review of sternal cultures received during the years 1995, 1996, and 1997 was performed. Of 267 acid-fast cultures obtained, none grew an organism. Of 289 sternal fungal cultures, none grew a fungus that was not found on the anaerobic culture (two yeast organisms were isolated). The charges for the acid-fast and fungal cultures were approximately $20,000 and $24,000, respectively.
Acid-fast and fungal cultures for sternal infection were unhelpful at our institution. There is a risk of a misleading contaminant's growth, with its attendant unnecessary treatments and toxicity. We believe it prudent not to routinely culture for acid-fast or fungal organisms unless anaerobic culture is negative and there is definite sternal inflammation.
Charleston Area Medical CenterDepartment of Pathology,
3100 MacCorkle Ave., SE,
Charleston, WV 2530412/8/90877
References
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Samuels LE, Sharma S, Morris RJ, Solomon MP, Granick MS, Wood CA, et al. Mycobacterium fortuitum infection of the sternum: review of the literature and case illustration. Arch Surg 1996;131:1344-6.[Abstract]
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Robicsek F, Hoffman PC, Masters TN, Daugherty HK, Cook JW, Selle JG, et al. Rapidly growing nontuberculous mycobacteria: a new enemy of the cardiac surgeon. Ann Thorac Surg 1988;46:703-10.[Abstract]
