Abstract
Wound contamination during open-heart surgery is the root of bacterial entry in the majority of cases of post-sternotomy mediastinitis (PSM). However, an alternative origin of infection, hematogenous metastasis from a remote body site, has been reported. We report a case of late-onset PSM with hematogenous metastasis of infection in a hemodialysis patient. A 75-year-old woman with hemodialysis was referred to our hospital with a complaint of high fever and chest swelling. She underwent aortic valve replacement via median sternotomy before 4 months. Emergent re-sternotomy revealed filled purulent discharge mediastinum despite complete sternal bony union. She also had left knee periprosthetic tissue and intrauterine device infections. Methicillin-resistant Staphylococcus aureus was detected in all three infected wounds and blood cultures. The mediastinal infection was well-controlled by negative pressure wound therapy with continuous irrigation; however, she died from multiple organ failure due to severe endocarditis infection. Patients on hemodialysis are prone to developing vascular access-associated bloodstream infections, including periprosthetic infections and infective endocarditis. The concordance of pathogens in the three distant wounds suggested that hematogenous metastasis of infection was the cause of late-onset PSM.
