A50-21 A Rare Case of Salmonella Infection in the Deep Sternum Post CABG

Introduction Salmonella is a gram negative bacteria often known to cause gastrointestinal infections. Its presentation in the chest tissue is rare and not well established in the current literature. We present a very rare case of salmonella infection in the deep sternal tissue post coronary artery bypass grafting in an otherwise healthy patient. Case Report A 62-year-old male with a past history of CAD s/p CABG 6 months before presentation, atrial fibrillation and diabetes was admitted for pain around his lower sternal area. Imaging done 3 months before presentation with CV surgery had shown inferior sternum fragments to be separated. This time the patient presented with fevers and chest pain. The physical exam did not reveal any erythema or drainage from the sternotomy site. Initial labs were significant for a white cell of 11.3. On admission CT scan showed new abnormality involving the most inferior sternal plate and screw fixation hardware and sternal wire with increasing fluid in inferior sternum. CT also showed diastases of the internal margins inferiorly. The patient was started on vancomycin, cefepime and metronidazole. Blood cultures were sent on admission which grew Salmonella. The patient underwent debridement of sternal infection with CV surgery on day 4 of admission which showed sternal separation in the inferior aspect and areas of purulence. Midline chest wound VAC was placed. Operative cultures were sent which eventually grew Salmonella species. Infectious disease was consulted and antibiotics were changed to ceftriaxone per susceptibilities. The patient remained stable post surgery and was eventually discharged with 6 weeks of ceftriaxone. Post discharge, CV surgery recommended plastic surgery for wound closure and the patient was then transferred to a higher level of care. Discussion Sternotomy wound infections post CABG are common, especially in immunocompromised patients or patients with uncontrolled diabetes. However, an infection with salmonella in the deep sternal tissue post-CABG is rare. This case brings forward an important microbiological consideration for clinicians and surgeons to keep in mind when dealing with sternotomy wound infections or abscesses.