Spore siege: Diagnostic and therapeutic challenges in fungal sternal osteomyelitis-a case series

Document Type

Article

Department

Medical College Pakistan; Surgery; Medicine

Abstract

Background: Deep sternal wound infections (DSWI) are rare but potentially fatal complications of cardiac surgery. While bacterial pathogens predominate, fungal involvement is a rare phenomenon coupled with high morbidity and mortality.
Aim: This study aimed to describe the clinical spectrum, management strategies, and outcomes of culture-proven fungal deep sternal wound infections following cardiac surgery at a tertiary care center, with particular emphasis on pathogen distribution, diagnostic challenges, therapeutic approaches, and patient outcomes, in order to enhance awareness of this rare but high-mortality entity and inform optimized, context-appropriate multidisciplinary care.
Methods: We conducted a retrospective review of seven patients with culture-proven fungal DSWI managed at Aga Khan University Hospital, Karachi, between 2019 and 2024. Clinical features, imaging, microbiology, treatment modalities, and outcomes were analyzed.
Results: The cohort included four adults and three pediatric patients (2 females and 5 males). Candida species were isolated in four cases and Aspergillus species in three, contrasting with global trends where Aspergillus predominates. All patients underwent surgical debridement combined with systemic antifungal therapy and adjunctive measures such as vacuum-assisted closure dressings with amphotericin-soaked gauze. Azoles were primarily used for both Aspergillus and Candida Species. Liposomal amphotericin B was reserved for severe or refractory cases due to nephrotoxicity. Five patients recovered with ongoing follow-up, while two mortalities were recorded, both in patients with multiple comorbidities and complicated postoperative courses.
Conclusion: Fungal sternal osteomyelitis is a rare but severe form of DSWI requiring early recognition, multimodal management, and multidisciplinary care. Our series highlights Candida as the predominant pathogen in this cohort, underscoring the importance of considering both yeast and mold infections in postoperative mediastinal complications. Individualized treatment strategies, timely surgical intervention, and judicious antifungal use are essential to improving outcomes, particularly in resource-limited settings.

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Publication (Name of Journal)

BMC Infect Dis

DOI

10.1186/s12879-026-13403-6

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