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Диагностика и лечение стерномедиастинита: обзор литературы
Диагностика и лечение стерномедиастинита: обзор литературы
Моисеев Д.А., Ховрин В.В., Винокуров И.А., Тагабилев Д.Г. Диагностика и лечение стерномедиастинита: обзор литературы. Consilium Medicum. 2026;28(1):1–8. DOI: 10.26442/20751753.2026.01.203526
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Аннотация
Стерномедиастинит после срединной стернотомии остается одним из самых тяжелых инфекционных осложнений кардиохирургических вмешательств, ассоциированным с длительной госпитализацией, потребностью в повторных операциях и высокой летальностью. Клиническая значимость проблемы увеличивается по мере роста числа операций на открытом сердце и доли пациентов с коморбидностью (сахарный диабет, ожирение, хроническая болезнь почек, хроническая обструктивная болезнь легких), которые ухудшают репарацию тканей и повышают риск глубокой инфекции грудины и медиастинальных структур.
Настоящий нарративный обзор обобщает данные о факторах риска, микробиологическом профиле, диагностических подходах и современных стратегиях лечения послеоперационного стерномедиастинита по материалам русско- и англоязычных публикаций 2015–2025 гг.
Среди предикторов осложнения наиболее последовательно обсуждаются нарушения углеводного обмена и ожирение, а также интраоперационные факторы (длительность вмешательства, повторная стернотомия, объем кровопотери и недостаточная фиксация при остеосинтезе).
Этиология чаще представлена грамположительными кокками, прежде всего Staphylococcus aureus (включая MRSA) и коагулазонегативными стафилококками, однако роль грамотрицательной и полимикробной флоры возрастает, что диктует необходимость широкого эмпирического покрытия с последующей деэскалацией по результатам посевов. Диагностика требует интеграции клинической оценки, динамического мониторинга маркеров воспаления и визуализации: компьютерная томография служит основным методом подтверждения глубокой инфекции и планирования вмешательства, тогда как позитронно-эмиссионная томография в сочетании с компьютерной томографией особенно полезна при хроническом или рецидивирующем течении и в сложных случаях.
Лечение рассматривается как мультидисциплинарная задача, включающая раннее начало антибактериальной терапии, радикальную хирургическую санацию с удалением некротических тканей и инфицированного материала, вакуум-ассистированную терапию для контроля раны и подготовку к реконструкции. Для восстановления грудной стенки применяют первичную или отсроченную репозицию грудины, лоскутную пластику и жесткую фиксацию титановыми системами, что повышает стабильность и потенциально снижает риск рецидива.
Перспективы связаны со стандартизацией диагностических и лечебных алгоритмов, оценкой новых биомаркеров и антибактериальных покрытий, развитием технологий фиксации, а также интеграцией гибридной визуализации и методов машинного обучения для раннего выявления осложнения.
Ключевые слова: стерномедиастинит, медиастинит, стернотомия, инфекция хирургической раны, терапия ран отрицательным давлением, компьютерная томография, позитронно-эмиссионная томография, антибактериальные препараты, золотистый стафилококк, метициллин-резистентный золотистый стафилококк
This narrative review summarizes data on risk factors, microbiological profiles, diagnostic approaches, and contemporary treatment strategies for postoperative sternomediastinitis based on Russian- and English-language publications from 2015 to 2025.
Among the predictors of this complication, disorders of carbohydrate metabolism and obesity are discussed most consistently, along with intraoperative factors such as operative duration, repeat sternotomy, blood loss volume, and inadequate sternal fixation during osteosynthesis.
The etiology is most commonly dominated by Gram-positive cocci, primarily Staphylococcus aureus (including methicillin-resistant strains, MRSA) and coagulase-negative staphylococci; however, the contribution of Gram-negative and polymicrobial flora has increased, necessitating broad empirical antimicrobial coverage followed by de-escalation based on culture results. Diagnosis requires an integrated approach combining clinical assessment, dynamic monitoring of inflammatory biomarkers, and imaging. Computed tomography serves as the principal modality for confirming deep infection and planning surgical intervention, whereas positron emission tomography/computed tomography is particularly useful in chronic or recurrent cases and in diagnostically challenging situations.
Treatment is regarded as a multidisciplinary task and includes early initiation of antimicrobial therapy, radical surgical debridement with removal of necrotic tissue and infected material, and the use of vacuum-assisted (negative pressure) wound therapy for local infection control and preparation for reconstruction. Chest wall reconstruction may involve primary or delayed sternal refixation, flap reconstruction, and rigid fixation using titanium systems, which improves stability and may reduce the risk of recurrence.
Future perspectives include the standardization of diagnostic and therapeutic algorithms, evaluation of novel biomarkers and antibacterial coatings, further development of fixation technologies, and the integration of hybrid imaging techniques and machine learning methods for early detection of this complication.
Keywords: mediastinitis, sternotomy, surgical wound infection, negative-pressure wound therapy, tomography, x-ray computed, positron-emission tomography, anti-bacterial agents, staphylococcus aureus, methicillin-resistant staphylococcus aureus
Настоящий нарративный обзор обобщает данные о факторах риска, микробиологическом профиле, диагностических подходах и современных стратегиях лечения послеоперационного стерномедиастинита по материалам русско- и англоязычных публикаций 2015–2025 гг.
Среди предикторов осложнения наиболее последовательно обсуждаются нарушения углеводного обмена и ожирение, а также интраоперационные факторы (длительность вмешательства, повторная стернотомия, объем кровопотери и недостаточная фиксация при остеосинтезе).
Этиология чаще представлена грамположительными кокками, прежде всего Staphylococcus aureus (включая MRSA) и коагулазонегативными стафилококками, однако роль грамотрицательной и полимикробной флоры возрастает, что диктует необходимость широкого эмпирического покрытия с последующей деэскалацией по результатам посевов. Диагностика требует интеграции клинической оценки, динамического мониторинга маркеров воспаления и визуализации: компьютерная томография служит основным методом подтверждения глубокой инфекции и планирования вмешательства, тогда как позитронно-эмиссионная томография в сочетании с компьютерной томографией особенно полезна при хроническом или рецидивирующем течении и в сложных случаях.
Лечение рассматривается как мультидисциплинарная задача, включающая раннее начало антибактериальной терапии, радикальную хирургическую санацию с удалением некротических тканей и инфицированного материала, вакуум-ассистированную терапию для контроля раны и подготовку к реконструкции. Для восстановления грудной стенки применяют первичную или отсроченную репозицию грудины, лоскутную пластику и жесткую фиксацию титановыми системами, что повышает стабильность и потенциально снижает риск рецидива.
Перспективы связаны со стандартизацией диагностических и лечебных алгоритмов, оценкой новых биомаркеров и антибактериальных покрытий, развитием технологий фиксации, а также интеграцией гибридной визуализации и методов машинного обучения для раннего выявления осложнения.
Ключевые слова: стерномедиастинит, медиастинит, стернотомия, инфекция хирургической раны, терапия ран отрицательным давлением, компьютерная томография, позитронно-эмиссионная томография, антибактериальные препараты, золотистый стафилококк, метициллин-резистентный золотистый стафилококк
________________________________________________
This narrative review summarizes data on risk factors, microbiological profiles, diagnostic approaches, and contemporary treatment strategies for postoperative sternomediastinitis based on Russian- and English-language publications from 2015 to 2025.
Among the predictors of this complication, disorders of carbohydrate metabolism and obesity are discussed most consistently, along with intraoperative factors such as operative duration, repeat sternotomy, blood loss volume, and inadequate sternal fixation during osteosynthesis.
The etiology is most commonly dominated by Gram-positive cocci, primarily Staphylococcus aureus (including methicillin-resistant strains, MRSA) and coagulase-negative staphylococci; however, the contribution of Gram-negative and polymicrobial flora has increased, necessitating broad empirical antimicrobial coverage followed by de-escalation based on culture results. Diagnosis requires an integrated approach combining clinical assessment, dynamic monitoring of inflammatory biomarkers, and imaging. Computed tomography serves as the principal modality for confirming deep infection and planning surgical intervention, whereas positron emission tomography/computed tomography is particularly useful in chronic or recurrent cases and in diagnostically challenging situations.
Treatment is regarded as a multidisciplinary task and includes early initiation of antimicrobial therapy, radical surgical debridement with removal of necrotic tissue and infected material, and the use of vacuum-assisted (negative pressure) wound therapy for local infection control and preparation for reconstruction. Chest wall reconstruction may involve primary or delayed sternal refixation, flap reconstruction, and rigid fixation using titanium systems, which improves stability and may reduce the risk of recurrence.
Future perspectives include the standardization of diagnostic and therapeutic algorithms, evaluation of novel biomarkers and antibacterial coatings, further development of fixation technologies, and the integration of hybrid imaging techniques and machine learning methods for early detection of this complication.
Keywords: mediastinitis, sternotomy, surgical wound infection, negative-pressure wound therapy, tomography, x-ray computed, positron-emission tomography, anti-bacterial agents, staphylococcus aureus, methicillin-resistant staphylococcus aureus
Полный текст
Список литературы
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50. Agarwal JP, Ogilvie M, Wu LC, et al. Vacuum-Assisted Closure for Sternal Wounds: A First-Line Therapeutic Management Approach. Plast Reconstr Surg. 2005;116(4):1035-40. DOI:10.1097/01.prs.0000178401.52143.32
51. Yu AW, Rippel RA, Smock E, Jarral OA. In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy? Interact Cardiovasc Thorac Surg. 2013;17(5):861-6. DOI:10.1093/icvts/ivt326
52. Tulain UR, Mahmood A, Aslam S, et al. Formulation and Evaluation of Linum usitatissimum Mucilage-Based Nanoparticles for Effective Delivery of Ezetimibe. Int J Nanomedicine. 2021;16:4579-96. DOI:10.2147/IJN.S308790
53. Pericleous A, Dimitrakakis G, Photiades R, Von Oppell UO. Assessment of vacuum-assisted closure therapy on the wound healing process in cardiac surgery. Int Wound J. 2016;13(6):1142-9. DOI:10.1111/iwj.12430
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55. Брюсов П.Г., Лищук А.Н., Потапов В.А. Развитие концепции комплексного лечения послеоперационного стерномедиастинита. Клиническая медицина. 2022;100(9-10):439-46 [Bryusov PG, Lishchuk AN, Potapov VA. Development of the concept of complex treatment postoperative sternomediastinitis. Clinical Medicine (Russian Journal). 2022;100(9-10):439-46 (in Russian)]. DOI:10.30629/0023-2149-2022-100-9-10-439-446 EDN:WFWTJQ
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57. Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg. 2017;12(1):94. DOI:10.1186/s13019-017-0656-7
58. Qiu X, Sun X, Huang G. Immediate flap increases patient safety for deep sternal wound infection: a meta-analysis. Int Wound J. 2023;20(8):3271-8. DOI:10.1111/iwj.14207
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60. Tamura K, Maruyama T, Sakurai S. Usefulness of sternal closure with bioresorbable plate in respiratory function after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2019;67(3):277-82. DOI:10.1007/s11748-018-1010-2
61. Makrygiannis IH, Nikolaidis AK, Tilaveridis I, et al. Coated sutures for use in oral surgery: a comprehensive review. Clin Oral Investig. 2025;29(2):109. DOI:10.1007/s00784-025-06176-w
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3. Abu-Omar Y, Kocher GJ, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017;51(1):10-29. DOI:10.1093/ejcts/ezw326
4. Jung Y, Lee KS, Oh SG, Jeong Y. Routine Mediastinal Drainage Fluid Culture for Early Diagnosis of Poststernotomy Mediastinitis. Thorac Cardiovasc Surg. 2023;71(1):46-52. DOI:10.1055/s-0042-1742617
5. Медведчиков-Ардия М.А., Корымасов Е.А., Бенян А.С. Методы лучевой диагностики инфекционных поражений грудины и ребер. Наука и инновации в медицине. 2022;7(3):212-6. DOI:10.35693/2500-1388-2022-7-3-212-216
6. Glaab J, Lobo-Ploch N, Cho HK, et al. Skin tolerant inactivation of multiresistant pathogens using far-UVC LEDs. Sci Rep. 2021;11(1):649. DOI:10.1038/s41598-021-94070-2
7. Vinokurov IA, Ivanov KP, Tagabilev DG. A new paradigm for the treatment of sternomediastinitis. Surgery. Journal named after N.I. Pirogov. 2023;(12):52 (in Russian). DOI:10.17116/hirurgia202312152 EDN:QAACMS
8. Forrester JD, Faliks B, Cardarelli C, et al. Surgical Infection Society–Chest Wall Injury Society Recommendations for Management of Surgical Site or Implant-Related Infections After Surgical Stabilization of Traumatic Rib or Sternal Fractures. Surg Infect (Larchmt). 2023;24(5):414-24. DOI:10.1089/sur.2023.086
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10. Ivert T, Berge A, Bratt S, Dalen M. Incidence and healing times of postoperative sternal wound infections: a retrospective observational single-centre study. Scand Cardiovasc J. 2024;58(1):2330349. DOI:10.1080/14017431.2024.2330349
11. Balachandran S, Lee A, Denehy L, et al. Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review. Ann Thorac Surg. 2016;102(6):2109-17. DOI:10.1016/j.athoracsur.2016.05.047
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14. Dell’Amore A, Congiu S, Campisi A, et al. Sternal reconstruction after post-sternotomy dehiscence and mediastinitis. Indian J Thorac Cardiovasc Surg. 2020;36(4):388-96. DOI:10.1007/s12055-019-00880-5
15. Tam DY, Nedadur R, Yu M, et al. Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac Surgery: A Meta-Analysis. Ann Thorac Surg. 2018;106(1):298-304. DOI:10.1016/j.athoracsur.2018.02.043
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17. Kasatov AV, Gorowitz ES. The value of various etiopathogens in the development of infectious complications after cardiac surgery with sternal access. Grekov's Bulletin of Surgery. 2022;181(5):78-82 (in Russian). DOI:10.24884/0042-4625-2022-181-5-78-82 EDN:JOYKQA
18. Heilmann C, Ziebuhr W, Becker K. Are coagulase-negative staphylococci virulent? Clin Microbiol Infect. 2019;25(9):1071-80. DOI:10.1016/j.cmi.2018.11.012
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20. Fernandez-Billon M, Llambias-Cabot AE, Jordana-Lluch E, et al. Mechanisms of antibiotic resistance in Pseudomonas aeruginosa biofilms. Biofilm. 2023;5:100129. DOI:10.1016/j.bioflm.2023.100129
21. Khan MS, Azam M, Khan MN, et al. Identification of contributing factors, microorganisms and antimicrobial resistance involved in the complication of diabetic foot ulcer treatment. Microb Pathog. 2023;184:106363. DOI:10.1016/j.micpath.2023.106363
22. Cirkovic I, Jocic D, Bozic DD, et al. The Effect of Vacuum-Assisted Closure Therapy on Methicillin-Resistant Staphylococcus aureus Wound Biofilms. Adv Skin Wound Care. 2018;31(8):361-4. DOI:10.1097/01.asw.0000540070.07040.70
23. Soprun L, Mironenko O, Tovanova A, Obuchov D, и др. Epidemiological and clinical features of the course of postoperative sternomediastinitis (clinical case). Vestnik of Saint-Petersburg University. Medicine. 2021;16(1):56-73 (in Russian). DOI:10.21638/spbu11.2021.107 EDN:VZRDKI
24. Ocampo DA, Hernandez CA, Mendoza F, et al. Sternal Osteomyelitis Caused by Mycobacterium tuberculosis in a Heart Transplant Patient. JACC Case Rep. 2025;30(5):103088. DOI:10.1016/j.jaccas.2024.103088
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49. Timsit JF, Bassetti M, Cremer O, et al. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med. 2019;45(2):172-89. DOI:10.1007/s00134-019-05520-5
50. Agarwal JP, Ogilvie M, Wu LC, et al. Vacuum-Assisted Closure for Sternal Wounds: A First-Line Therapeutic Management Approach. Plast Reconstr Surg. 2005;116(4):1035-40. DOI:10.1097/01.prs.0000178401.52143.32
51. Yu AW, Rippel RA, Smock E, Jarral OA. In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy? Interact Cardiovasc Thorac Surg. 2013;17(5):861-6. DOI:10.1093/icvts/ivt326
52. Tulain UR, Mahmood A, Aslam S, et al. Formulation and Evaluation of Linum usitatissimum Mucilage-Based Nanoparticles for Effective Delivery of Ezetimibe. Int J Nanomedicine. 2021;16:4579-96. DOI:10.2147/IJN.S308790
53. Pericleous A, Dimitrakakis G, Photiades R, Von Oppell UO. Assessment of vacuum-assisted closure therapy on the wound healing process in cardiac surgery. Int Wound J. 2016;13(6):1142-9. DOI:10.1111/iwj.12430
54. Shevchenko AA, Topalov KP, Zhila NG, Kashkarov EA. Surgical treatment of sternal osteomyelitis and sternomediastinitis following cardiac surgery. Surgery. Journal named after N.I. Pirogov. 2021;(9):34 (in Russian). DOI:10.17116/hirurgia202109134 EDN:TZSSHM
55. Bryusov PG, Lishchuk AN, Potapov VA. Development of the concept of complex treatment postoperative sternomediastinitis. Clinical Medicine (Russian Journal). 2022;100(9-10):439-46 (in Russian). DOI:10.30629/0023-2149-2022-100-9-10-439-446 EDN:WFWTJQ
56. Potapov VA, Bryusov PG, Surova MV, Musailov VA. Reconstructive treatment of patients with deep sternal infection. Bulletin of Pirogov National medical & surgical center. 2022;17(2):87-94 (in Russian). DOI:10.25881/20728255_2022_17_2_87 EDN:QHIIZZ
57. Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg. 2017;12(1):94. DOI:10.1186/s13019-017-0656-7
58. Qiu X, Sun X, Huang G. Immediate flap increases patient safety for deep sternal wound infection: a meta-analysis. Int Wound J. 2023;20(8):3271-8. DOI:10.1111/iwj.14207
59. Hever P, Singh P, Eiben I, et al. The management of deep sternal wound infection: literature review and reconstructive algorithm. JPRAS Open. 2021;28:77-89. DOI:10.1016/j.jpra.2021.02.007
60. Tamura K, Maruyama T, Sakurai S. Usefulness of sternal closure with bioresorbable plate in respiratory function after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2019;67(3):277-82. DOI:10.1007/s11748-018-1010-2
61. Makrygiannis IH, Nikolaidis AK, Tilaveridis I, et al. Coated sutures for use in oral surgery: a comprehensive review. Clin Oral Investig. 2025;29(2):109. DOI:10.1007/s00784-025-06176-w
2. De Tymowski C, Provenchere S, Para M, et al. Deep sternal wound infection after cardiac surgery: A combination of 2 distinct infection types, deep incisional surgical-site infection and mediastinitis: Results of a retrospective study. Surgery. 2025;181:109255. DOI:10.1016/j.surg.2025.109255
3. Abu-Omar Y, Kocher GJ, Bosco P, et al. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis. Eur J Cardiothorac Surg. 2017;51(1):10-29. DOI:10.1093/ejcts/ezw326
4. Jung Y, Lee KS, Oh SG, Jeong Y. Routine Mediastinal Drainage Fluid Culture for Early Diagnosis of Poststernotomy Mediastinitis. Thorac Cardiovasc Surg. 2023;71(1):46-52. DOI:10.1055/s-0042-1742617
5. Медведчиков-Ардия М.А., Корымасов Е.А., Бенян А.С. Методы лучевой диагностики инфекционных поражений грудины и ребер. Наука и инновации в медицине. 2022;7(3):212-6. DOI:10.35693/2500-1388-2022-7-3-212-216
6. Glaab J, Lobo-Ploch N, Cho HK, et al. Skin tolerant inactivation of multiresistant pathogens using far-UVC LEDs. Sci Rep. 2021;11(1):649. DOI:10.1038/s41598-021-94070-2
7. Винокуров ИА, Иванов КП, Тагабилев ДГ, и др. Новая парадигма лечения стерномедиастинита. Хирургия. Журнал им. Н.И. Пирогова. 2023;(12):52 [Vinokurov IA, Ivanov KP, Tagabilev DG. A new paradigm for the treatment of sternomediastinitis. Surgery. Journal named after N.I. Pirogov. 2023;(12):52 (in Russian)]. DOI:10.17116/hirurgia202312152 EDN:QAACMS
8. Forrester JD, Faliks B, Cardarelli C, et al. Surgical Infection Society–Chest Wall Injury Society Recommendations for Management of Surgical Site or Implant-Related Infections After Surgical Stabilization of Traumatic Rib or Sternal Fractures. Surg Infect (Larchmt). 2023;24(5):414-24. DOI:10.1089/sur.2023.086
9. Винник ЮС, Сакович ВА, Чередниченко МВ, Дунаевская СС. Анализ развития стернальной инфекции у кардиохирургических больных. Дальневосточный медицинский журнал. 2020;(1):51-4 [Vinnik YuS, Sakovich VA, Cherednichenko MB, Dunaevkaya SS. Analysis of development of sternal infection in cardiac patients. Far Eastern Medical Journal. 2020;(1):51-4 (in Russion)]. DOI:10.35177/1994-5191-2020-1-51-54 EDN:TLTPFG
10. Ivert T, Berge A, Bratt S, Dalen M. Incidence and healing times of postoperative sternal wound infections: a retrospective observational single-centre study. Scand Cardiovasc J. 2024;58(1):2330349. DOI:10.1080/14017431.2024.2330349
11. Balachandran S, Lee A, Denehy L, et al. Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review. Ann Thorac Surg. 2016;102(6):2109-17. DOI:10.1016/j.athoracsur.2016.05.047
12. Chen D, Zhang J, Wang Y, et al. Risk factors for sternal wound infection after open-heart operations: A systematic review and meta-analysis. Int Wound J. 2024;21(3):e14457. DOI:10.1111/iwj.14457
13. Cheng H, Chen BPH, Soleas IM, et al. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017;18(6):722-35. DOI:10.1089/sur.2017.089
14. Dell’Amore A, Congiu S, Campisi A, et al. Sternal reconstruction after post-sternotomy dehiscence and mediastinitis. Indian J Thorac Cardiovasc Surg. 2020;36(4):388-96. DOI:10.1007/s12055-019-00880-5
15. Tam DY, Nedadur R, Yu M, et al. Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac Surgery: A Meta-Analysis. Ann Thorac Surg. 2018;106(1):298-304. DOI:10.1016/j.athoracsur.2018.02.043
16. Remy KE, Hall MW, Cholette J, et al. Mechanisms of red blood cell transfusion-related immunomodulation. Transfusion. 2018;58(3):804-15. DOI:10.1111/trf.14488
17. Касатов А.В., Горовиц Э.С. Значение различных этиопатогенов в развитии инфекционных осложнений после кардиохирургических вмешательств через стернальный доступ. Вестник хирургии им. И.И. Грекова. 2022;181(5):78-82 [Kasatov AV, Gorowitz ES. The value of various etiopathogens in the development of infectious complications after cardiac surgery with sternal access. Grekov's Bulletin of Surgery. 2022;181(5):78-82 (in Russian)]. DOI:10.24884/0042-4625-2022-181-5-78-82 EDN:JOYKQA
18. Heilmann C, Ziebuhr W, Becker K. Are coagulase-negative staphylococci virulent? Clin Microbiol Infect. 2019;25(9):1071-80. DOI:10.1016/j.cmi.2018.11.012
19. Aleidan F, Alkhelaifi H, Alsenaid A, et al. Incidence and risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care units: a matched case-control study. Expert Rev Anti Infect Ther. 2021;19(3):393-8. DOI:10.1080/14787210.2020.1822736
20. Fernandez-Billon M, Llambias-Cabot AE, Jordana-Lluch E, et al. Mechanisms of antibiotic resistance in Pseudomonas aeruginosa biofilms. Biofilm. 2023;5:100129. DOI:10.1016/j.bioflm.2023.100129
21. Khan MS, Azam M, Khan MN, et al. Identification of contributing factors, microorganisms and antimicrobial resistance involved in the complication of diabetic foot ulcer treatment. Microb Pathog. 2023;184:106363. DOI:10.1016/j.micpath.2023.106363
22. Cirkovic I, Jocic D, Bozic DD, et al. The Effect of Vacuum-Assisted Closure Therapy on Methicillin-Resistant Staphylococcus aureus Wound Biofilms. Adv Skin Wound Care. 2018;31(8):361-4. DOI:10.1097/01.asw.0000540070.07040.70
23. Сопрун Л.А., Мироненко О.В., Тованова А.А., Обухов Д.А. Эпидемиологические и клинические особенности течения послеоперационного стерномедиастенита (клинический случай). Вестник Санкт-Петербургского университета. Медицина. 2021;16(1):56-73 [Soprun L, Mironenko O, Tovanova A, Obuchov D, и др. Epidemiological and clinical features of the course of postoperative sternomediastinitis (clinical case). Vestnik of Saint-Petersburg University. Medicine. 2021;16(1):56-73 (in Russian)]. DOI:10.21638/spbu11.2021.107 EDN:VZRDKI
24. Ocampo DA, Hernandez CA, Mendoza F, et al. Sternal Osteomyelitis Caused by Mycobacterium tuberculosis in a Heart Transplant Patient. JACC Case Rep. 2025;30(5):103088. DOI:10.1016/j.jaccas.2024.103088
25. Winarto H, Habiburrahman M, Anggraeni TD, et al. The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models. J Clin Med. 2022;12(1):96. DOI:10.3390/jcm12010096
26. Shevchuk VA, Odushkina NV, Tkachenko MV, et al. Etiological characteristics and antibiotic sensitivity of causative agents of purulent-inflammatory diseases of the maxillofacial region. Child’s Health. 2025;20(2):136-43. DOI:10.22141/2224-0551.20.2.2025.1804
27. Shirke MM, Dominic C, Debnath P, et al. Computed Tomography Scanning for Sternal Wound Infections: A Systematic Review. Ulster Med J. 2024;92(3):139-47.
28. Jolles H, Henry DA, Roberson JP, et al. Mediastinitis following median sternotomy: CT findings. Radiology. 1996;201(2):463-6. DOI:10.1148/radiology.201.2.8888241
29. Arnon-Sheleg E, Israel O, Keidar Z. PET/CT Imaging in Soft Tissue Infection and Inflammation-An Update. Semin Nucl Med. 2020;50(1):35-49. DOI:10.1053/j.semnuclmed.2019.07.005
30. Zhang R, Feng Z, Zhang Y, et al. Diagnostic value of fluorine-18 deoxyglucose positron emission tomography/computed tomography in deep sternal wound infection. J Plast Reconstr Aesthet Surg. 2018;71(12):1768-76. DOI:10.1016/j.bjps.2018.07.017
31. Cai A, Bakhshi M, Lamarche Y, et al. Prospective evaluation of the diagnostic accuracy of FDG-PET/CT for the detection of sternal wound infection post-sternotomy. EJNMMI Rep. 2025;9(1):6. DOI:10.1186/s41824-024-00237-1
32. Liu S, Zhang J, Yin H, et al. The value of 18F-FDG PET/CT in diagnosing and localising deep sternal wound infection to guide surgical debridement. Int Wound J. 2020;17(4):1019-27. DOI:10.1111/iwj.13368
33. Van Leer B, Haitsma Mulier JLG, Van Stee CP, et al. [18F]FDG PET/CT identifies infectious and inflammatory foci in persistent critical illness. Ann Intensive Care. 2025;15(1):24. DOI:10.1186/s13613-025-01444-0
34. Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU. FDG PET/CT in infection and inflammation-current and emerging clinical applications. Clin Radiol. 2015;70(7):787-800. DOI:10.1016/j.crad.2015.03.010
35. Lawal I, Sathekge M. F-18 FDG PET/CT imaging of cardiac and vascular inflammation and infection. Br Med Bull. 2016;120(1):55-74. DOI:10.1093/bmb/ldw035
36. Besson FL, Nocturne G, Noël N, et al. PET/CT in Inflammatory and Auto-immune Disorders: Focus on Several Key Molecular Concepts, FDG, and Radiolabeled Probe Perspectives. Semin Nucl Med. 2024;54(3):379-93. DOI:10.1053/j.semnuclmed.2023.10.005
37. Pijl JP, Nienhuis PH, Kwee TC, et al. Limitations and Pitfalls of FDG-PET/CT in Infection and Inflammation. Semin Nucl Med. 2021;51(6):633-45. DOI:10.1053/j.semnuclmed.2021.06.008
38. Mayerhoefer ME, Prosch H, Beer L, et al. PET/MRI versus PET/CT in oncology: a prospective single-center study of 330 examinations focusing on implications for patient management and cost considerations. Eur J Nucl Med Mol Imaging. 2020;47(1):51-60. DOI:10.1007/s00259-019-04452-y
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40. Yang Q, Li M, Cao X, et al. An umbrella review of meta-analyses on diagnostic accuracy of C-reactive protein. Int J Surg. 2022;104:106788. DOI:10.1016/j.ijsu.2022.106788
41. Falk G, Fahey T. C-reactive protein and community-acquired pneumonia in ambulatory care: systematic review of diagnostic accuracy studies. Fam Pract. 2008;26(1):10-21. DOI:10.1093/fampra/cmn095
42. Kondo Y, Umemura Y, Hayashida K, et al. Diagnostic value of procalcitonin and presepsin for sepsis in critically ill adult patients: a systematic review and meta-analysis. J Intensive Care. 2019;7(1):22. DOI:10.1186/s40560-019-0374-4
43. Hoeboer SH, Van Der Geest PJ, Nieboer D, Groeneveld ABJ. The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clin Microbiol Infect. 2015;21(5):474-81. DOI:10.1016/j.cmi.2014.12.026
44. Liu X, Lian J, Liu F, et al. Clinical application of combined CRP and PCT detection in diagnosing and prognosing fracture-related infections. Front Cell Infect Microbiol. 2025;15:1563170. DOI:10.3389/fcimb.2025.1563170
45. Li B. C-reactive Protein (CRP) and Procalcitonin (PCT) Combined Testing in the Diagnosis of Elderly Patients with Bacterial Pneumonia. J Clin Nurs Res. 2025;9(1):299-304. DOI:10.26689/jcnr.v9i1.9516
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47. Шафер ЯВ. Современная эмпирическая антибактериальная терапия у больных с послеоперационным стерномедиастинитом. World Science. 2019;2(3(43)):42-5. DOI:10.31435/rsglobal_ws/31032019/6410
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49. Timsit JF, Bassetti M, Cremer O, et al. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med. 2019;45(2):172-89. DOI:10.1007/s00134-019-05520-5
50. Agarwal JP, Ogilvie M, Wu LC, et al. Vacuum-Assisted Closure for Sternal Wounds: A First-Line Therapeutic Management Approach. Plast Reconstr Surg. 2005;116(4):1035-40. DOI:10.1097/01.prs.0000178401.52143.32
51. Yu AW, Rippel RA, Smock E, Jarral OA. In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy? Interact Cardiovasc Thorac Surg. 2013;17(5):861-6. DOI:10.1093/icvts/ivt326
52. Tulain UR, Mahmood A, Aslam S, et al. Formulation and Evaluation of Linum usitatissimum Mucilage-Based Nanoparticles for Effective Delivery of Ezetimibe. Int J Nanomedicine. 2021;16:4579-96. DOI:10.2147/IJN.S308790
53. Pericleous A, Dimitrakakis G, Photiades R, Von Oppell UO. Assessment of vacuum-assisted closure therapy on the wound healing process in cardiac surgery. Int Wound J. 2016;13(6):1142-9. DOI:10.1111/iwj.12430
54. Шевченко А.А., Топалов К.П., Жила Н.Г., Кашкаров Е.А. Хирургическое лечение остеомиелита грудины и стерномедиастинита вследствие кардиохирургических операций. Хирургия. Журнал им. Н.И. Пирогова. 2021;(9):34 [Shevchenko AA, Topalov KP, Zhila NG, Kashkarov EA. Surgical treatment of sternal osteomyelitis and sternomediastinitis following cardiac surgery. Surgery. Journal named after N.I. Pirogov. 2021;(9):34 (in Russian)]. DOI:10.17116/hirurgia202109134 EDN:TZSSHM
55. Брюсов П.Г., Лищук А.Н., Потапов В.А. Развитие концепции комплексного лечения послеоперационного стерномедиастинита. Клиническая медицина. 2022;100(9-10):439-46 [Bryusov PG, Lishchuk AN, Potapov VA. Development of the concept of complex treatment postoperative sternomediastinitis. Clinical Medicine (Russian Journal). 2022;100(9-10):439-46 (in Russian)]. DOI:10.30629/0023-2149-2022-100-9-10-439-446 EDN:WFWTJQ
56. Потапов В.А., Брюсов П.Г., Сурова М.В., Мусаилов В.А. Реконструктивное лечение больных глубокой стернальной инфекцией. Вестник Национального медико-хирургического центра им. Н.И. Пирогова. 2022;17(2):87-94 [Potapov VA, Bryusov PG, Surova MV, Musailov VA. Reconstructive treatment of patients with deep sternal infection. Bulletin of Pirogov National medical & surgical center. 2022;17(2):87-94 (in Russian)]. DOI:10.25881/20728255_2022_17_2_87 EDN:QHIIZZ
57. Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg. 2017;12(1):94. DOI:10.1186/s13019-017-0656-7
58. Qiu X, Sun X, Huang G. Immediate flap increases patient safety for deep sternal wound infection: a meta-analysis. Int Wound J. 2023;20(8):3271-8. DOI:10.1111/iwj.14207
59. Hever P, Singh P, Eiben I, et al. The management of deep sternal wound infection: literature review and reconstructive algorithm. JPRAS Open. 2021;28:77-89. DOI:10.1016/j.jpra.2021.02.007
60. Tamura K, Maruyama T, Sakurai S. Usefulness of sternal closure with bioresorbable plate in respiratory function after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2019;67(3):277-82. DOI:10.1007/s11748-018-1010-2
61. Makrygiannis IH, Nikolaidis AK, Tilaveridis I, et al. Coated sutures for use in oral surgery: a comprehensive review. Clin Oral Investig. 2025;29(2):109. DOI:10.1007/s00784-025-06176-w
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23. Soprun L, Mironenko O, Tovanova A, Obuchov D, и др. Epidemiological and clinical features of the course of postoperative sternomediastinitis (clinical case). Vestnik of Saint-Petersburg University. Medicine. 2021;16(1):56-73 (in Russian). DOI:10.21638/spbu11.2021.107 EDN:VZRDKI
24. Ocampo DA, Hernandez CA, Mendoza F, et al. Sternal Osteomyelitis Caused by Mycobacterium tuberculosis in a Heart Transplant Patient. JACC Case Rep. 2025;30(5):103088. DOI:10.1016/j.jaccas.2024.103088
25. Winarto H, Habiburrahman M, Anggraeni TD, et al. The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models. J Clin Med. 2022;12(1):96. DOI:10.3390/jcm12010096
26. Shevchuk VA, Odushkina NV, Tkachenko MV, et al. Etiological characteristics and antibiotic sensitivity of causative agents of purulent-inflammatory diseases of the maxillofacial region. Child’s Health. 2025;20(2):136-43. DOI:10.22141/2224-0551.20.2.2025.1804
27. Shirke MM, Dominic C, Debnath P, et al. Computed Tomography Scanning for Sternal Wound Infections: A Systematic Review. Ulster Med J. 2024;92(3):139-47.
28. Jolles H, Henry DA, Roberson JP, et al. Mediastinitis following median sternotomy: CT findings. Radiology. 1996;201(2):463-6. DOI:10.1148/radiology.201.2.8888241
29. Arnon-Sheleg E, Israel O, Keidar Z. PET/CT Imaging in Soft Tissue Infection and Inflammation-An Update. Semin Nucl Med. 2020;50(1):35-49. DOI:10.1053/j.semnuclmed.2019.07.005
30. Zhang R, Feng Z, Zhang Y, et al. Diagnostic value of fluorine-18 deoxyglucose positron emission tomography/computed tomography in deep sternal wound infection. J Plast Reconstr Aesthet Surg. 2018;71(12):1768-76. DOI:10.1016/j.bjps.2018.07.017
31. Cai A, Bakhshi M, Lamarche Y, et al. Prospective evaluation of the diagnostic accuracy of FDG-PET/CT for the detection of sternal wound infection post-sternotomy. EJNMMI Rep. 2025;9(1):6. DOI:10.1186/s41824-024-00237-1
32. Liu S, Zhang J, Yin H, et al. The value of 18F-FDG PET/CT in diagnosing and localising deep sternal wound infection to guide surgical debridement. Int Wound J. 2020;17(4):1019-27. DOI:10.1111/iwj.13368
33. Van Leer B, Haitsma Mulier JLG, Van Stee CP, et al. [18F]FDG PET/CT identifies infectious and inflammatory foci in persistent critical illness. Ann Intensive Care. 2025;15(1):24. DOI:10.1186/s13613-025-01444-0
34. Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU. FDG PET/CT in infection and inflammation-current and emerging clinical applications. Clin Radiol. 2015;70(7):787-800. DOI:10.1016/j.crad.2015.03.010
35. Lawal I, Sathekge M. F-18 FDG PET/CT imaging of cardiac and vascular inflammation and infection. Br Med Bull. 2016;120(1):55-74. DOI:10.1093/bmb/ldw035
36. Besson FL, Nocturne G, Noël N, et al. PET/CT in Inflammatory and Auto-immune Disorders: Focus on Several Key Molecular Concepts, FDG, and Radiolabeled Probe Perspectives. Semin Nucl Med. 2024;54(3):379-93. DOI:10.1053/j.semnuclmed.2023.10.005
37. Pijl JP, Nienhuis PH, Kwee TC, et al. Limitations and Pitfalls of FDG-PET/CT in Infection and Inflammation. Semin Nucl Med. 2021;51(6):633-45. DOI:10.1053/j.semnuclmed.2021.06.008
38. Mayerhoefer ME, Prosch H, Beer L, et al. PET/MRI versus PET/CT in oncology: a prospective single-center study of 330 examinations focusing on implications for patient management and cost considerations. Eur J Nucl Med Mol Imaging. 2020;47(1):51-60. DOI:10.1007/s00259-019-04452-y
39. Vinokurov IA, Belov YuV, Tagabilev DG, Yusupov SA. Postoperative sternomediastinitis: morphology of lesion, treatment strategy. Surgery. Journal named after N.I. Pirogov. 2024;(7):78 (in Russion). DOI:10.17116/hirurgia202407178 EDN:HHCUMY
40. Yang Q, Li M, Cao X, et al. An umbrella review of meta-analyses on diagnostic accuracy of C-reactive protein. Int J Surg. 2022;104:106788. DOI:10.1016/j.ijsu.2022.106788
41. Falk G, Fahey T. C-reactive protein and community-acquired pneumonia in ambulatory care: systematic review of diagnostic accuracy studies. Fam Pract. 2008;26(1):10-21. DOI:10.1093/fampra/cmn095
42. Kondo Y, Umemura Y, Hayashida K, et al. Diagnostic value of procalcitonin and presepsin for sepsis in critically ill adult patients: a systematic review and meta-analysis. J Intensive Care. 2019;7(1):22. DOI:10.1186/s40560-019-0374-4
43. Hoeboer SH, Van Der Geest PJ, Nieboer D, Groeneveld ABJ. The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clin Microbiol Infect. 2015;21(5):474-81. DOI:10.1016/j.cmi.2014.12.026
44. Liu X, Lian J, Liu F, et al. Clinical application of combined CRP and PCT detection in diagnosing and prognosing fracture-related infections. Front Cell Infect Microbiol. 2025;15:1563170. DOI:10.3389/fcimb.2025.1563170
45. Li B. C-reactive Protein (CRP) and Procalcitonin (PCT) Combined Testing in the Diagnosis of Elderly Patients with Bacterial Pneumonia. J Clin Nurs Res. 2025;9(1):299-304. DOI:10.26689/jcnr.v9i1.9516
46. Potapov VA, Kohan EP, Asanov ON, Musailov VA. Use of vacuum therapy and bacteriophages in the complex treatment of deep sternal wound infection. Bulletin of Pirogov National medical & surgical center. 2021;16(2):66-71 (in Russian). DOI:10.25881/20728255_2021_16_2_66 EDN:AEOOBO
47. Шафер ЯВ. Современная эмпирическая антибактериальная терапия у больных с послеоперационным стерномедиастинитом. World Science. 2019;2(3(43)):42-5. DOI:10.31435/rsglobal_ws/31032019/6410
48. De Waele JJ, Schouten J, Beovic B, et al. Antimicrobial de-escalation as part of antimicrobial stewardship in intensive care: no simple answers to simple questions – a viewpoint of experts. Intensive Care Med. 2020;46(2):236-44. DOI:10.1007/s00134-019-05871-z
49. Timsit JF, Bassetti M, Cremer O, et al. Rationalizing antimicrobial therapy in the ICU: a narrative review. Intensive Care Med. 2019;45(2):172-89. DOI:10.1007/s00134-019-05520-5
50. Agarwal JP, Ogilvie M, Wu LC, et al. Vacuum-Assisted Closure for Sternal Wounds: A First-Line Therapeutic Management Approach. Plast Reconstr Surg. 2005;116(4):1035-40. DOI:10.1097/01.prs.0000178401.52143.32
51. Yu AW, Rippel RA, Smock E, Jarral OA. In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy? Interact Cardiovasc Thorac Surg. 2013;17(5):861-6. DOI:10.1093/icvts/ivt326
52. Tulain UR, Mahmood A, Aslam S, et al. Formulation and Evaluation of Linum usitatissimum Mucilage-Based Nanoparticles for Effective Delivery of Ezetimibe. Int J Nanomedicine. 2021;16:4579-96. DOI:10.2147/IJN.S308790
53. Pericleous A, Dimitrakakis G, Photiades R, Von Oppell UO. Assessment of vacuum-assisted closure therapy on the wound healing process in cardiac surgery. Int Wound J. 2016;13(6):1142-9. DOI:10.1111/iwj.12430
54. Shevchenko AA, Topalov KP, Zhila NG, Kashkarov EA. Surgical treatment of sternal osteomyelitis and sternomediastinitis following cardiac surgery. Surgery. Journal named after N.I. Pirogov. 2021;(9):34 (in Russian). DOI:10.17116/hirurgia202109134 EDN:TZSSHM
55. Bryusov PG, Lishchuk AN, Potapov VA. Development of the concept of complex treatment postoperative sternomediastinitis. Clinical Medicine (Russian Journal). 2022;100(9-10):439-46 (in Russian). DOI:10.30629/0023-2149-2022-100-9-10-439-446 EDN:WFWTJQ
56. Potapov VA, Bryusov PG, Surova MV, Musailov VA. Reconstructive treatment of patients with deep sternal infection. Bulletin of Pirogov National medical & surgical center. 2022;17(2):87-94 (in Russian). DOI:10.25881/20728255_2022_17_2_87 EDN:QHIIZZ
57. Kaul P. Sternal reconstruction after post-sternotomy mediastinitis. J Cardiothorac Surg. 2017;12(1):94. DOI:10.1186/s13019-017-0656-7
58. Qiu X, Sun X, Huang G. Immediate flap increases patient safety for deep sternal wound infection: a meta-analysis. Int Wound J. 2023;20(8):3271-8. DOI:10.1111/iwj.14207
59. Hever P, Singh P, Eiben I, et al. The management of deep sternal wound infection: literature review and reconstructive algorithm. JPRAS Open. 2021;28:77-89. DOI:10.1016/j.jpra.2021.02.007
60. Tamura K, Maruyama T, Sakurai S. Usefulness of sternal closure with bioresorbable plate in respiratory function after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg. 2019;67(3):277-82. DOI:10.1007/s11748-018-1010-2
61. Makrygiannis IH, Nikolaidis AK, Tilaveridis I, et al. Coated sutures for use in oral surgery: a comprehensive review. Clin Oral Investig. 2025;29(2):109. DOI:10.1007/s00784-025-06176-w
Авторы
Д.А. Моисеев*, В.В. Ховрин, И.А. Винокуров, Д.Г. Тагабилев
ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского» Миннауки и высшего образования России, Москва, Российская Федерация
*dimois2005@mail.ru
Petrovsky Russian Scientific Center of Surgery, Moscow, Russian Federation
*dimois2005@mail.ru
ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского» Миннауки и высшего образования России, Москва, Российская Федерация
*dimois2005@mail.ru
________________________________________________
Petrovsky Russian Scientific Center of Surgery, Moscow, Russian Federation
*dimois2005@mail.ru
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