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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...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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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. |
format | Online Article Text |
id | pubmed-10673517 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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