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OBJECTIVES: To evaluate a simple treatment algorithm in sternal wound infection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and mortality. METHODS: A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis were used to determine preoperative and perioperative risks factors for 90-day and long-term mortality. RESULTS: Out of 5905 procedures, 146 sternal wound infections were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1%, and 3.2%. Pathogens involved were S. epidermidis (44.5%), S. aureus (31.5%), and gram-negative rods (19.2%). Re-operation was required in 131/146 patients. Mean time to the first re-operation was 17.3+/-12 days. Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), debridement, rewiring and mediastinal lavage (52 patients), and partial/complete sternal resection (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI were 4.4% and 2.8% (p=0.78) whereas for patients with deep SWI, 90-day mortality was 14.5% (DSWI vs others, p

Scrub typhus should be considered in any febrile patient presenting with a macular rash, a polyadenopathy, an eschar, or a history of environmental exposure in endemic areas. The differential diagnosis includes malaria, typhoid fever, leptospirosis, and arboviroses. Doxycycline 100 mg twice daily for 7 days should be initiated as soon as the disease is suspected.

Indications for surgery were (i) severe congestive heart failure (NYHA class III) in 21 patients (32%) and cardiogenic shock in nine of them (14%), (ii) septic emboli in 22 patients (35%) including 10 cases (16%) of stroke with no intracranial bleeding, 5 cases (8%) of TIAs and3 cases (4.7%) ofcerebral abscesses and(iii) persistent sepsis in11 patients (17%). Preoperative transoesophageal echocardiography revealed vegetations in 51 patients (81%), mitral regurgitation (MR) grade 3 in 40 patients (63.5%) and intracardiac abscesses or fistulas in 17 patients (27%). Forty-two patients (67%) had isolated mitral valve endocarditis, 20 (32%) had both mitral and aortic valve endocarditis and one had mitral and tricuspid valve endocarditis. Immediate postoperative transoesophageal echocardiography indicated no residual MR in 48 patients (76.2%) and MR grade 1 in13 patients (21.6%). Inonly two patients (3.2%), a residual MRof grade2 was acceptedbecause of advanced age. NoMV stenosis was observed at this time.