Fulminant mediastinitis due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: atypical presentation and spreading following cardiac surgery

Valenzuela, H.; Carrascal, Yolanda; Maroto, L.; Arce, Núria

doi:10.1093/icvts/ivt051

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…In addition, infection with these microorganisms was associated with a poorer prognosis in subjects with mediastinitis. Charbonneau et al [ 269 ] showed that in-hospital mortality at 30 days was significantly higher in patients with GNB mediastinitis compared to those caused by Gram-positive bacteria (31.9% versus 17.0%; p = 0.004) [ 269 , 271 ].…”

Section: Medical Managementmentioning

confidence: 99%

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Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

Bouza

Alarcón

Fariñas

et al. 2021

JCM

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This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.

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Section: Medical Managementmentioning

confidence: 99%

“…Although Gram-positive microorganisms are the cause of most cases of post-sternotomy mediastinitis, some authors have reported a prevalence of Gram-negative bacilli (GNB) infection of up to 56.7% ( K. pneumoniae 16.4%) [ 271 ].…”

Section: Medical Managementmentioning

confidence: 99%

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

Bouza

Alarcón

Fariñas

et al. 2021

JCM

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“…GNB PSM is associated with a more severe outcome, leading to a decrease in survival. Evidence of increasing multidrug-resistant (MDR) GNB infecting DSWI is a great concern and are likely to increase in number in future years [17,19,20]. The proportion of patients with PSM of fungal cause is below 5%.…”

Section: Key Pointsmentioning

confidence: 99%

“…Of interest that an outbreak of PSM caused by Serratia marcescens because of contamination of the aqueous chlorhexidine solution used to prepare the patients’ skin has been reported [18]. Evidence of increasing multidrug-resistant (MDR) GNB infecting DSWI is a great concern and are likely to increase in number in future years [17,19,20]. The proportion of patients with PSM of fungal cause is below 5%.…”

Section: Microbiological Causementioning

confidence: 99%

Gram-negative bacteria as a cause of mediastinitis after cardiac surgery

Peghin

Pompei

Vendramin

et al. 2021

Current Opinion in Infectious Diseases

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Purpose of reviewPoststernotomy mediastinitis (PSM) remains a serious infection and is significantly associated with high morbidity, short-term and long-term mortality. Gram-negative bacteria (GNB) are an underestimated cause of PSM, and there is little information on the risk factors, prevention, diagnosis and management of GNB PSM. Recent findingsThe pathogenesis of PSM is the result of a complex and multifactorial interplay between intraoperative wound contamination, host-related and surgical host factors but GNB are probably mostly translocated from other host site infections. GNB are frequent cause of PSM (18-38% of cases) and GNB PSM have shown to more frequently polymicrobial (20-44%). GNG PSM has shown to occur earlier than Grampositive PSM. Early diagnosis is crucial to successful treatment. The management of PSM needs a combination of culture-directed antimicrobial therapy and an early extensive surgical debridement with either immediate or delayed closure of the sternal space. Antibiotic treatment choice and duration should be based on clinical evaluation, evolution of inflammatory markers, microbiological tests and imaging studies. Mortality has shown to be significantly higher with GNB PSM compared with other causes and the inappropriateness of initial antibiotic therapy may explain the worse outcome of GNB PSM. SummaryGNB PSM is usually undervalued in the setting of PSM and have shown to be a frequent cause of inappropriate treatment with adverse prognostic potential. There is a need for efforts to improve knowledge to prevent and adequately treat GNB PSM.

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Infecciones por enterobacterias productoras de betalactamasas de espectro extendido tras cirugía cardiaca: su impacto en la mortalidad

Rodríguez-Vidigal¹,

Vera-Tomé²,

Nogales-Muñoz³

et al. 2016

Revista Colombiana de Cardiología

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Fulminant mediastinitis due to extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: atypical presentation and spreading following cardiac surgery

Cited by 4 publications

References 4 publications

Gram-negative bacteria as a cause of mediastinitis after cardiac surgery

Infecciones por enterobacterias productoras de betalactamasas de espectro extendido tras cirugía cardiaca: su impacto en la mortalidad

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