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Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature

Sternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery f...

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Autores principales: Pignatti, Marco, Dolci, Giampiero, Zamagni, Elena, Pascale, Renato, Piccin, Ottavio, Ammar, Alessandro, Zeneli, Flavia, Miralles, Maria Elisa Lozano, Mancuso, Katia, Cipriani, Riccardo, Viale, Pierluigi, Pacini, Davide, Martin-Suàrez, Sofia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673517/
https://www.ncbi.nlm.nih.gov/pubmed/38004712
http://dx.doi.org/10.3390/microorganisms11112699
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author Pignatti, Marco
Dolci, Giampiero
Zamagni, Elena
Pascale, Renato
Piccin, Ottavio
Ammar, Alessandro
Zeneli, Flavia
Miralles, Maria Elisa Lozano
Mancuso, Katia
Cipriani, Riccardo
Viale, Pierluigi
Pacini, Davide
Martin-Suàrez, Sofia
author_facet Pignatti, Marco
Dolci, Giampiero
Zamagni, Elena
Pascale, Renato
Piccin, Ottavio
Ammar, Alessandro
Zeneli, Flavia
Miralles, Maria Elisa Lozano
Mancuso, Katia
Cipriani, Riccardo
Viale, Pierluigi
Pacini, Davide
Martin-Suàrez, Sofia
author_sort Pignatti, Marco
collection PubMed
description Sternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery for severe aortic valve stenosis, followed by sternal wound dehiscence and sternum osteomyelitis due to extended spectrum beta lactamase (ESBL) producing Klebsiella aerogenes. A multiple myeloma diagnosis was also suspected at the positron emission tomography (PET) scan and confirmed with bone marrow biopsy. Multidisciplinary evaluation of the case led to a comprehensive treatment plan. To control the sternal osteomyelitis, total sternectomy was performed followed by immediate reconstruction with a bone (tibia) graft from the tissue bank and fixation with the minimal hardware possible. A microsurgical latissimus dorsi free flap was required to reconstruct the soft tissue defect. After 6 weeks of antibiotic treatment with ertapenem and fosfomycin based on a culture of intraoperative material, no clinical, imaging, or laboratory signs of infection were seen. Multiple myeloma treatment was then started. At 1 year of follow up, no recurrence of infection occurred, and the reconstruction was stable and closed. Multiple myeloma is under chronic treatment with novel agent combination, with an excellent haematological response.
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spelling pubmed-106735172023-11-03 Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature Pignatti, Marco Dolci, Giampiero Zamagni, Elena Pascale, Renato Piccin, Ottavio Ammar, Alessandro Zeneli, Flavia Miralles, Maria Elisa Lozano Mancuso, Katia Cipriani, Riccardo Viale, Pierluigi Pacini, Davide Martin-Suàrez, Sofia Microorganisms Case Report Sternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery for severe aortic valve stenosis, followed by sternal wound dehiscence and sternum osteomyelitis due to extended spectrum beta lactamase (ESBL) producing Klebsiella aerogenes. A multiple myeloma diagnosis was also suspected at the positron emission tomography (PET) scan and confirmed with bone marrow biopsy. Multidisciplinary evaluation of the case led to a comprehensive treatment plan. To control the sternal osteomyelitis, total sternectomy was performed followed by immediate reconstruction with a bone (tibia) graft from the tissue bank and fixation with the minimal hardware possible. A microsurgical latissimus dorsi free flap was required to reconstruct the soft tissue defect. After 6 weeks of antibiotic treatment with ertapenem and fosfomycin based on a culture of intraoperative material, no clinical, imaging, or laboratory signs of infection were seen. Multiple myeloma treatment was then started. At 1 year of follow up, no recurrence of infection occurred, and the reconstruction was stable and closed. Multiple myeloma is under chronic treatment with novel agent combination, with an excellent haematological response. MDPI 2023-11-03 /pmc/articles/PMC10673517/ /pubmed/38004712 http://dx.doi.org/10.3390/microorganisms11112699 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Pignatti, Marco
Dolci, Giampiero
Zamagni, Elena
Pascale, Renato
Piccin, Ottavio
Ammar, Alessandro
Zeneli, Flavia
Miralles, Maria Elisa Lozano
Mancuso, Katia
Cipriani, Riccardo
Viale, Pierluigi
Pacini, Davide
Martin-Suàrez, Sofia
Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
title Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
title_full Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
title_fullStr Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
title_full_unstemmed Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
title_short Multidisciplinary Management of Sternal Osteomyelitis Due to Klebsiella aerogenes after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
title_sort multidisciplinary management of sternal osteomyelitis due to klebsiella aerogenes after open heart surgery in a patient with multiple myeloma: a case report and discussion of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673517/
https://www.ncbi.nlm.nih.gov/pubmed/38004712
http://dx.doi.org/10.3390/microorganisms11112699
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