Comprehensive Evaluation of Clinical Outcomes, Risk Factors, and Evidence-Based Management Strategies for Deep Sternal Wound Infections Following Coronary Artery Bypass Grafting (CABG) Surgery

Abstract

Background: Deep sternal wound infections (DSWIs) are rare but life-threatening complications following coronary artery bypass grafting (CABG), especially among patients with comorbidities such as diabetes mellitus. These infections significantly affect morbidity, prolong hospitalization, and require intensive, multidisciplinary management.

Case Presentation: A 59-year-old female with a known history of poorly controlled type 2 diabetes mellitus was admitted to CMC Hospital in Erbil, Iraq, following elective CABG surgery. Postoperatively, the patient developed a non-healing thoracic wound, with incomplete sternal closure and clinical signs of deep infection, including purulent discharge, erythema, and systemic fever. Microbiological analysis of wound swabs identified a polymicrobial infection involving Staphylococcus aureus and Pseudomonas aeruginosa. The patient was managed with surgical debridement, targeted antibiotic therapy based on culture sensitivity, and advanced wound care using negative-pressure wound therapy (NPWT).

Discussion: This case illustrates the increased susceptibility of diabetic patients to postoperative wound infections due to impaired immunity and delayed healing. It emphasizes the importance of early detection, thorough microbiological assessment, and an individualized, evidence-based treatment plan. Preoperative glycemic control, stringent intraoperative asepsis, and prompt postoperative wound monitoring are essential to minimize the risk of DSWIs.

Conclusion: Deep sternal wound infections following CABG present significant clinical challenges, particularly in diabetic patients. This case from CMC Hospital in Erbil, Iraq, underscores the need for timely intervention, multidisciplinary care, and the integration of advanced wound management strategies to improve clinical outcomes.