Incidence of Sternal Wound Infection in Cardiac Surgery Unit, Zagazig University Hospitals and Different Modalities for its Management

Background: Sternal wound infection remains one of the most serious complications after median sternotomy in cardiac surgery, particularly in resource-limited healthcare settings. This study aimed to evaluate whether a more aggressive staged approach can reduce morbidity and mortality following post-cardiotomy sternal wound infection. Methods: A prospective cross-sectional study was conducted at the Cardiothoracic Surgery Department, where twenty-four consecutive adult patients with sternal wound infection following cardiac surgery were enrolled. All patients underwent systematic evaluation including clinical examination, laboratory testing, microbiological culture, and imaging when indicated. Management followed a predefined staged protocol: conservative antibiotic therapy; local surgical debridement with Redivac drainage; and negative-pressure wound therapy (NPWT) for cases failing debridement. Outcomes, microbiology, and complications were recorded. Results: The mean age of the cohort was 52.1±11.1years; 66.7% were male. Major risk factors included coronary artery disease (75%), hypertension (66.7%), and diabetes mellitus (41.7%). Conservative treatment achieved successful healing in 33.3% of patients, while 66.6% required escalation. Surgical debridement with closed suction drainage was successful in 68.8% of those who underwent the procedure. NPWT achieved complete wound healing in all remaining 5 patients who failed debridement, resulting in an overall 100% healing rate with zero mortality. Klebsiella pneumoniae emerged as the predominant pathogen, increasing in prevalence across treatment stages (29.2%→43.8%→60%). Complication rates were low, with arrhythmias (12.5%), hemorrhage (8.3%), and wound dehiscence (4.2%) representing the most reported events. Conclusion: A staged management protocol incorporating early surgical debridement and NPWT is highly effective in achieving complete wound healing and preventing mortality in post-cardiotomy SWI.