Enterobacter-Related Deep Sternal Wound Infection After Cardiac Surgery with Delayed NPWT Success: A Rare Case Report

Background: Deep sternal wound infection (DSWI) is a rare but serious complication following cardiac surgery, particularly in high-risk patients with comorbidities such as diabetes, COPD, and a history of smoking. Socioeconomic barriers can further compromise outcomes, especially in resource-limited countries. Case Presentation: We report a 70-year-old male with diabetes, COPD, hypertension, and heavy smoking history who developed DSWI 20 days after coronary artery bypass grafting (CABG), following early discontinuation of antibiotics due to crisis-related non-adherence. He presented with fever, sternal instability, and wound dehiscence. Cultures identified Enterobacter spp, and treatment included targeted antibiotics and delayed initiation of negative-pressure wound therapy (NPWT). The patient achieved wound granulation and stabilization without the need for flap reconstruction. Conclusion: This case highlights the importance of early DSWI recognition, multidisciplinary management, and the efficacy of NPWT even when initiated late. It also underscores the impact of systemic challenges on adherence and recovery, and the need for tailored prevention strategies in resource-constrained environments.