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

1 / 13 Case Report 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 Marco Pignatti 1,2,*, Giampiero Dolci 3, Elena Zamagni 2,4, Renato Pascale 2,5, Ottavio Piccin 6, Alessandro Ammar 1,7, Flavia Zeneli 1,7, Maria Elisa Lozano Miralles 1,7, Katia Mancuso 2,4, Riccardo Cipriani 1, Pierluigi Viale 2,7, Davide Pacini 2,8 and Sofia Martin-Suàrez 8 1 Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; marco.pignatti@unibo.it (M.P.); alessandro.ammar@icloud.com (A.A.); flaviazeneli@yahoo.com (F.Z.); mariaelisa.lozano@gmail.com (M.E.L.M.); riccardo.cipriani@aosp.bo.it (R.C.) 2 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; e.zamagni@unibo.it (E.Z.); renato.pascale2@unibo.it (R.P.); katia.mancuso3@unibo.it (K.M.); pierluigi.viale@unibo.it (P.V.); davide.pacini@unibo.it (D.P.) 3 Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; dolci.giampiero@gmail.com 4 Haematology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy 5 Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy 6 Otorinolaryngology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; ottavio.piccin2@unibo.it 7 Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy 8 Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; sofia.martinsuarez@aosp.bo.it * Correspondence: marco.pignatti@unibo.it Abstract: 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 un-derwent 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 per-formed 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 re-quired 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 mye-loma is under chronic treatment with novel agent combination, with an excellent haematological response.