Emerging Role of Candida in Deep Sternal Wound Infection

Background. This study evaluated the overall incidence, prognosis, and risk factors for microbiologically documented Candida deep sternal wound infection (DSWI) after cardiac operations. Methods. A retrospective observational study was performed at Aalborg Hospital, Aarhus University Hospital, Denmark, from January 1999 through November 2006. Included were all 83 of 4222 cardiac surgical patients with microbiologically documented DSWI requiring surgical revision. Various potential risk factors in patients with Candida DSWI were compared with those of patients with non-Candida DSWI. We compared markers of morbidity, in-hospital mortality, and 1-year mortality to evaluate the prognosis of the disease. Results. DSWI developed in 2% of all patients, of whom, 17 (20.5%) had Candida DSWI, and 66 (79.5%) had non-Candida etiology. Candida was the primary causative organism in 11 of 17 Candida DSWI cases. No Candida DSWI was found during the first 3 years of the study. In-hospital and 1-year mortality were doubled in patients with Candida DSWI compared with patients with non-Candida DSWI. Candida DSWI was associated with significantly longer stay in the intensive care unit and need of prolonged mechanical ventilation. Risk factors for Candida etiology were Candida colonization in tracheal secretions or urine and reoperation before diagnosis of DSWI. Conclusions. Candida was a frequent causative agent of DSWI in our series and was associated with a very high morbidity and mortality. Cardiothoracic patients on mechanical ventilation when colonized with Candida were identified as a high-risk population for subsequent development of Candida DSWI.