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Chronic Serratia marcescens sternal infection presenting 13 years after coronary artery surgery.
Int J Surg Case Rep 2019; 62:50-53IJ

Abstract

INTRODUCTION

Serratia marcescens is a facultative anaerobic bacillus that very rarely causes sternal infections. We describe a sternal abscess resulting from chronic S. marcescens infection that presented 13 years after coronary artery bypass graft surgery (CABG).

PRESENTATION OF CASE

A 71-year-old diabetic man presented 13 years after CABG with a new distal sternal "mass" that intermittently drained purulent fluid. He was treated with oral antibiotics, but the symptoms persisted. Exploration revealed an abscess extending to the sternal body. A non-absorbable braided suture and a sternal wire were removed, but a sinus tract remained despite further antibiotics and conservative care. Subsequent computed tomography and bone scintigraphy revealed a substernal soft tissue density with bone involvement. An abscess cavity was excised from the substernal anterior mediastinum. Another non-absorbable braided suture was removed. Cultures grew carbapenem-resistant S. marcescens.

DISCUSSION

Nosocomial or hospital-associated clusters of S. marcescens infection are known, but isolated infections seldom occur. S. marcescens infections in cardiac surgery patients are unusual. Only a single report described a chronic sternal infection resulting from S. marcescens that was identified 15 years after an initial episode caused by the same organism in a heart transplant recipient who was immunocompromised. Diabetes and non-absorbable braided sutures placed for hemostasis at the wire sites were probably contributing factors to our patient's chronic infection.

CONCLUSION

This report described the presentation and treatment of a chronic S. marcescens sternal abscess that occurred 13 years after CABG. Chronic sternal infections due to this organism in cardiac surgery patients are exceeding rare.

Authors+Show Affiliations

Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States.Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States.Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States; Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.Department of Anesthesiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States. Electronic address: pspagel@mcw.edu.Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31445500

Citation

Chinn, Ashley, et al. "Chronic Serratia Marcescens Sternal Infection Presenting 13 Years After Coronary Artery Surgery." International Journal of Surgery Case Reports, vol. 62, 2019, pp. 50-53.
Chinn A, Knabel M, Sanger JR, et al. Chronic Serratia marcescens sternal infection presenting 13 years after coronary artery surgery. Int J Surg Case Rep. 2019;62:50-53.
Chinn, A., Knabel, M., Sanger, J. R., Pagel, P. S., & Almassi, G. H. (2019). Chronic Serratia marcescens sternal infection presenting 13 years after coronary artery surgery. International Journal of Surgery Case Reports, 62, pp. 50-53. doi:10.1016/j.ijscr.2019.08.007.
Chinn A, et al. Chronic Serratia Marcescens Sternal Infection Presenting 13 Years After Coronary Artery Surgery. Int J Surg Case Rep. 2019 Aug 17;62:50-53. PubMed PMID: 31445500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic Serratia marcescens sternal infection presenting 13 years after coronary artery surgery. AU - Chinn,Ashley, AU - Knabel,Michael, AU - Sanger,James R, AU - Pagel,Paul S, AU - Almassi,G Hossein, Y1 - 2019/08/17/ PY - 2019/07/15/received PY - 2019/08/02/revised PY - 2019/08/10/accepted PY - 2019/8/25/pubmed PY - 2019/8/25/medline PY - 2019/8/25/entrez KW - CABG KW - Coronary artery disease KW - Mediastinitis KW - Serratia mercescens KW - Sternal infection SP - 50 EP - 53 JF - International journal of surgery case reports JO - Int J Surg Case Rep VL - 62 N2 - INTRODUCTION: Serratia marcescens is a facultative anaerobic bacillus that very rarely causes sternal infections. We describe a sternal abscess resulting from chronic S. marcescens infection that presented 13 years after coronary artery bypass graft surgery (CABG). PRESENTATION OF CASE: A 71-year-old diabetic man presented 13 years after CABG with a new distal sternal "mass" that intermittently drained purulent fluid. He was treated with oral antibiotics, but the symptoms persisted. Exploration revealed an abscess extending to the sternal body. A non-absorbable braided suture and a sternal wire were removed, but a sinus tract remained despite further antibiotics and conservative care. Subsequent computed tomography and bone scintigraphy revealed a substernal soft tissue density with bone involvement. An abscess cavity was excised from the substernal anterior mediastinum. Another non-absorbable braided suture was removed. Cultures grew carbapenem-resistant S. marcescens. DISCUSSION: Nosocomial or hospital-associated clusters of S. marcescens infection are known, but isolated infections seldom occur. S. marcescens infections in cardiac surgery patients are unusual. Only a single report described a chronic sternal infection resulting from S. marcescens that was identified 15 years after an initial episode caused by the same organism in a heart transplant recipient who was immunocompromised. Diabetes and non-absorbable braided sutures placed for hemostasis at the wire sites were probably contributing factors to our patient's chronic infection. CONCLUSION: This report described the presentation and treatment of a chronic S. marcescens sternal abscess that occurred 13 years after CABG. Chronic sternal infections due to this organism in cardiac surgery patients are exceeding rare. SN - 2210-2612 UR - https://www.unboundmedicine.com/medline/citation/31445500/Chronic_Serratia_marcescens_sternal_infection_presenting_13_years_after_coronary_artery_surgery L2 - https://linkinghub.elsevier.com/retrieve/pii/S2210-2612(19)30470-5 DB - PRIME DP - Unbound Medicine ER -