**1. Introduction**

282 Special Topics in Cardiac Surgery

[103] J Petraitis V, Petraitiene R, et al. Triazole-polyene antagonism in experimental invasive

[104] Viscoli C. Combination therapy for invasive aspergillosis. Clin Infect Dis 2004;39:803-5. [105] Vazquez JA. Clinical practice: combination antifungal therapy for mold infections:

[106] Nguyen MH; Peacock JE; et al. Therapeutic approaches in patients with candidemia:

[107] Luzzati R, Amalfitano G, et al. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 2000; 19:602–7. [108] Rex JH, Bennett JE, et al. Intravascular catheter exchange and duration of candidemia:

[109] Nucci, M; Anaissie, E. Should vascular catheters be removed from all patients with candidemia? An evidence-based review. Clin Infect Dis 2002;34:591–99. [110] Walsh TJ, Rex JH. All catheter-related candidemia is not the same: assessment of the

[111] Sullivan KM, Dykewicz CA, et al. Preventing opportunistic infections after

[112] Partridge-Hinckley K, Liddell GM, et al. Infection control measures to prevent invasive

[113] Infection Control Guidelines Control and Prevention of Aspergillosis. 2002 Pages 1-10

[114] Saha DC, Goldman DL, et al. Serologic evidence for reactivation of cryptococcosis in solid-organ transplant recipients. Clin Vaccine Immunol 2007;14:1550–4. [115] Marr KA. Empirical antifungal therapy-new options, new tradeoffs. N Engl J Med

much ado about nothing? Clin Infect Dis 2008;46:1889-901.

18.

1995;155: 2429–35.

1995;21:994–6.

2002;34:600-2.

2001;1:392-421.

2002; 346:278-80.

Mycopathol;168:329-37.

Last revised August 2007.

pulmonary aspergillosis: in vitro and in vivo correlation. J Infect Dis 2006; 194:1008-

evaluation in a multicenter, prospective, observational study. Arch Intern Med

Niaid Mycoses Study Group and the Candidemia Study Group. Clin Infect Dis

balance the risks and benefits of removal of vascular catheters. Clin Infect Dis

hematopoietic stem cell transplantation: The Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation practice guidelines and beyond. Hematology

mould diseases in hematopoietic stem cell transplant recipients.

Median sternotomy is a commonly performed incision with distinct advantages for exposure of mediastinal and pulmonary hilar structures [1]. However, a well-defined incidence of wound complications is associated with sternotomy, which are costly and potentially lethal in cases of deep sternal wound infection (DSWI) or mediastinitis [2-13]. Not only is DSWI associated with significant perioperative mortality, but historically even successfully treated DSWI is associated with reduced mid- and long-term survival compared with matched cardiac surgical patients without this dreaded postoperative complication [7-12].

In the past 10 years, we have accumulated extensive experience with managing DSWI as a referral center for these difficult problems. We and others have formalized a protocol for managing mediastinal infection utilizing negative pressure wound therapy which allows sternal salvage and improved outcomes in the majority of cases of DSWI [14-16]. This report describes our protocol for managing mediastinitis and presents our results for the past 18 years.
