sternal infection after triple bypass

My stepmom had triple bypass surgery May 11, 2008.  She is still hospitalized almost 6 months later due to multiple complications including atrial fib, congestive heart failure, pneumonia, multiple wound infections (staph epi, pseudomonas, MRSA), DVT's, and malnutrition (30% weight loss, now 94lbs). She barely survived a recent episode of sepsis. Blood cultures were negative, urine culture positive for yeast and klebsiella and sternal wound with MRSA. She was deathly ill and became essentially unresponsive. Multiple antibiotics were tried without success. Two newly available antibiotics were started and those seemed to pull her out of it. She has also had several episodes of c-diff. She lost her swallow reflex during the sepsis episode, got it back, but now is thought to have been aspirating pureed nectar. Past medical history is significant for lung cancer (LLL lobectomy), emphysema, asthma, COPD, and fingertip amputation from a staph infection. Her chest wound has been opened by a surgeon serveral times due to infection. Most of the time, a wound vac was used and the wound was very small until this last episode of infection.  She was supposed to have a muscle flap when medically stable.Within a week or so since stopping the antibiotics, she again has MRSA in her wound. The wound was cleaned out (again) by a surgeon this past week and presumed to have osteomyelitis (we thought she had it earlier). How to you treat a persistent wound infection after such a complicated course? Is it possible to successfully treat an osteo with MRSA? How do you treat and for how long? Do you remove the sternum? We are seeking a additional second opinions and possible transfer to another facility. Handwashing has been a significant problem from the beginning of her hospitalization - from nurses to doctors, not following posted handwashing and isolation signs despite being asked to.

[Cleveland Clinic]

This is a very difficult problem to deal with.  Osteomyelitis is extremely difficult to treat with any ABx because of poor blood flow to bone tissue in general.  MRSA makes it more difficult because the Abx that we have are not that strong.  Taking the sternum out is an option but that's a last resort approach.  The biggest concern is that without a sternum, the stability of the chest which is essential for respiration, coughing, etc, is greatly compromised.  If the Abx are working now, and seem to control the system manifestations of infection, then the other option is to continue with IV Abx for a couple of months, followed by chronic suppression with chronic oral antibiotics based on sensitivies.  Bactrim is frequently used.  But again, that depends on the bacterial sensitivity.  This is a serious condition and should be dealt with by an experienced physician.  I would definitely consider transferring her to a tertiary care center.