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Journal of Clinical Microbiology, November 2004, p. 5245-5248, Vol. 42, No. 11
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.11.5245-5248.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Armand Mekontso-Dessap,1* Stéphanie Honoré,2 Matthias Kirsch,3 Rémi Houël,3 Daniel Loisance,3 and Christian Brun-Buisson1

Service de Réanimation Médicale,1 Laboratoire de Bactériologie,2 Service de Chirurgie Thoracique et Cardiovasculaire, Centre Hospitalier Universitaire Henri Mondor, Créteil, France3

Received 25 November 2003/ Returned for modification 22 June 2004/ Accepted 23 July 2004

Poststernotomy mediastinitis (PSM) is one of the most serious complications of cardiac surgery, and its associated morbidity and mortality demand early recognition for emergency therapy. In this study, we investigated the usefulness of epicardial pacing wire (EPW) cultures for the prediction of PSM. Among 2,200 patients who underwent a cardiac surgical procedure at our hospital between 1 January 1999 and 31 December 2001, 82 (3.7%) had PSM; Staphylococcus aureus was the organism (45.1%) most frequently isolated at the time of surgical debridement. EPWs from 1,607 (73.0%) patients, 73 (4.5%) of whom developed PSM, were cultured. EPW cultures from 466 (29.0%) were positive, most often (74.9%) for coagulase-negative Staphylococci. EPW cultures were truly positive in 26 cases, truly negative in 1,106 cases, falsely positive in 428 cases, and falsely negative in 47 cases (with sterile cultures in 35 cases and a culture positive for an organism different from that isolated at the time of debridement in 12 cases). EPW culture had a positive predictive value of only 5.7% and a high negative predictive value (95.9%) for the diagnosis of PSM, with an accuracy of 70.4%. However, the likelihood ratio of positive (1.27) and negative (0.89) tests indicated only small changes in pretest-to-posttest probability. Therefore, a strategy of routine culture of EPWs to predict PSM seems questionable.

* Corresponding author. Mailing address: Service de Réanimation Médicale, Centre Hospitalier Universitaire Henri Mondor, 51 avenue du Mal de Lattre de Tassigny, 94010 Créteil Cédex, France. Phone: 33149812391. Fax: 33142079943. E-mail: armand.dessap{at}creteil.inserm.fr.

Journal of Clinical Microbiology, November 2004, p. 5245-5248, Vol. 42, No. 11
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.11.5245-5248.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.





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