Infection du site opératoire après chirurgie cardiaque

Sternal infection (SI) is a severe complication of cardiac surgery. Definitions are multiple explaining changes of incidence, (up to 5% of patients). The pathophysiology is complex and several modes of contamination are considered (pre-, per- and postoperative). Treatment is based on a medico-surgical management. Several surgical techniques are currently performed among which primary closure and drainage with Redon drain (RD). A bacteriological analysis of RD liquid is made twice a week and RD are mobilized after at least 3 consecutives negatives cultures and two weeks of drainage. This practice allows a simple postoperative course with low risk of infection. Antibiotic therapy should be multiple and bactericide. Duration (2 to 6 weeks) depends on the type of SI. In case of endocarditis, antibiotic duration is dictated by the latter. SI prevention includes assessing peroperative anesthetic risk, diabetes equilibration, chronic staphylococcal carriage decontamination and choice of surgical technique in case of bypass surgery.