Suppurative Mediastinitis after Open Heart Surgery

Newman, Lee S.; Szczukowski, Lori C.; Bain, Raymond P.; Perlino, Carl A.

doi:10.1378/chest.94.3.546

Cited by 92 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Those often include purulent discharge from the mediastinal area (11,12,16), in some cases together with fever (Ն38°C) and sternal dehiscence (4,10,18). L'Ecuyer et al, who did not include purulent discharge or sternal dehiscence in their criteria for chest infection, found that those signs occurred in only 67% and 26% of the patients, respectively (8).…”

mentioning

confidence: 99%

Mediastinitis after Cardiac Surgery: Improvement of Bacteriological Diagnosis by Use of Multiple Tissue Samples and Strain Typing

Tammelin¹,

Hambræus²,

Ståhle

2002

J Clin Microbiol

View full text Add to dashboard Cite

The diagnosis of postsurgical mediastinitis (PSM) among patients with sternal wound complication (SWC) after cardiac surgery is sometimes difficult, as fever, elevated C-reactive protein levels, and chest pain can be caused by a general inflammatory reaction to the operative trauma and/or sternal dehiscence without infection. The definitions of PSM usually used emphasize clinical signs and symptoms easily observed by the surgeon. The aim of the study was to investigate whether the use of standardized multiple tissue sampling, optimal culturing methods, and strain typing, together with a microbiological criterion for infection, could identify more infected patients than clinical assessment alone. Patients reexplored due to SWC after cardiac artery bypass grafting (CABG) or heart valve replacement (HVR) with or without CABG performed at the Department for Cardio-Thoracic Surgery at the Uppsala University Hospital between 10 March 1998 and 9 September 2000 were investigated prospectively. Tissue samples were taken from the sternum or adjacent mediastinal tissue, preferably before the administration of antibiotics. Culturing was performed both directly (on agar plates) and using enrichment broth. Species identification was performed by standard methods, and strain typing was performed by pulsed-field gel electrophoresis. A total of 41 cases with at least five tissue samples each were included in the study group. Of these patients, 32 were infected according to the microbiological criterion (i.e., the same strain was found in >50% of the samples). Staphylococcus epidermidis was the primary pathogen in 38% of the cases (12/32), S. aureus was the primary pathogen in 31% (10/32), P. acnes was the primary pathogen in 25% (8/32), and S. simulans and S. haemolyticus were the primary pathogens in 3% (1/32) each. All cases of S. aureus infection and 86% (12/14) of coagulase-negative staphylococcus (CoNS) infections were identified from primary cultures. All cases fulfilling the microbiological criterion for S. aureus infection were clinically diagnosed as cases of infection, but among the 14 cases fulfilling the criterion for microbiological diagnosis of CoNS infection, only 10 appeared to qualify clinically as cases of infection. Among the patients with sternal dehiscence in whom a microbiological diagnosis was established, 67% (12/18) had a CoNS infection, compared to 14% (2/14) of those without sternal dehiscence. The difference was statistically significant. PSM caused by S. aureus is readily identified by the surgeon, whereas 30% of cases with CoNS infections may be misinterpreted as noninfected. Multiple sampling before administration of antibiotics, primary culturing on agar plates, species identification, strain typing, and susceptibility testing should be used to ensure a fast and microbiologically correct diagnosis which identifies the primary pathogen and infected patients among those with minor infective symptoms. The role of P. acnes as a possible cause of PSM needs further investigation. PSM caused by CoNS is s...

show abstract

mentioning

confidence: 99%

Mediastinitis after Cardiac Surgery: Improvement of Bacteriological Diagnosis by Use of Multiple Tissue Samples and Strain Typing

Tammelin¹,

Hambræus²,

Ståhle

2002

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…Sex is one such individual feature. Male sex was determined as a predictor of major infections after sur- [9] 2008 55/43 1500 Prospective Adult CABG Lopez Gude et al [26] 2006 109/54 490 Prospective Adult Combined Filsoufi et al [21] 2009 42/64 5798 Retrospective Adult CABG Ridderstolpe et al [31] 2001 213/78 3008 Retrospective Adult Combined Tiveron et al [25] 2012 26/9 2768 Prospective Adult Combined Newman et al [35] 1988 58/10 204 Retrospective Adult Combined Wouters et al [27] 1994…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we thought that the results of these studies are disputable for overall analysis. However, when we performed the analysis by excluding eleven studies, [4,7,12,15,19,23,24,26,28,35] analysis results did not change (OR, 1.11; 95% CI, 0.89-1.39; p=0.33).…”

mentioning

confidence: 84%

See 1 more Smart Citation

Does gender predict development of mediastinitis?

Öztürk

2017

EJMO

View full text Add to dashboard Cite

T he rate of developing mediastinitis after cardiac surgery is approximately 0.8%-5.6%. [1,2] Although the rate of occurrence of mediastinitis is low, mediastinitis causes complications, such as the need for intra-aortic balloon pump or inotropic drug support, ventricular or supraventricular arrhythmias, stroke, and myocardial ischemia, leading to reduction in long-term survival. [3,4] Mediastinal infections can be caused by direct contamination, hematogenous spread, or through extension of infection from the neck, retroperitoneum, lung, pleura, or chest wall.[5] Mediastinal infections are defined as microbiological or clinical infection of presternal tissue. There are two types of mediastinal infections: superficial or deep wound infections (mediastinitis).[6] Superficial wound infections involve only the skin and subcutaneous tissue; however, mediastinitis is the wound infection that includes sternal osteomyelitis which spreads to retrosternal space. [6] There are many risk factors for the development of mediastinitis: diabetes mellitus, obesity, age, peripheral artery disease, smoking, previous cardiac surgery, >5-h long surgery, and length of stay in intensive care unit. [7,8] There are few clinical studies alleging that sex is a risk factor for the development of mediastinitis after cardiac surgery; [9,10] however, there is no evidence. Therefore, we aimed to analyze whether sex is a risk factor for the development of mediastinitis after cardiac surgery. Methods Search StrategyWe searched PubMed database for articles according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) [11] to determine whether the sex of patients could predict devel- Objectives:We aimed to analyze whether sex was a risk factor for the development of mediastinitis after cardiac surgery. Methods: Literature screening was performed using PubMed database without date limitation. Trial results were evaluated with random or fixed-effect model according to the heterogeneity. Statistical evaluation was performed. Results: In total, 4044 articles were obtained after database searching. Of all these articles, 32 articles containing 1.11.303 patients, which satisfied the inclusion criteria, were included in the meta-analysis. The rate of mediastinitis was 2.19%. The effect size was observed as heterogeneous (Q: 89.09, df(Q): 31, p:0.00, I2:65.20%). Analysis results according to the random effect model were as follows: OR (odds ratio), 1.09; 95% CI, 0.90-1.32; and p=0.34 (p>0.05). Conclusion:The results of the quantitative analysis showed that a patient's sex does not predict the development of mediastinitis after cardiac surgery for children and/or adults.

show abstract

“…(1,2) The mean incidence in the largest, most recent reviews is approximately 1%. (2)(3)(4) A second operation for debridement and drainage, together with long-term hospitalization for antibiotic therapy and Aggressive treatment using muscle flaps or omentopexy in infections of the sternum and anterior mediastinum following sternotomy* Tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno mediastino anterior em pós-operatório de esternotomia a technique with which others have also obtained favorable results.…”

Section: Introductionmentioning

confidence: 99%

Tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno e mediastino anterior em pós-operatório de esternotomia

et al. 2008

View full text Add to dashboard Cite

OBJETIVO: Avaliar o impacto do tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno e mediastino anterior em pós-operatório de esternotomia sobre a mortalidade, comparando-o ao do tratamento conservador. MÉTODOS: Foram coletados dados pré-, trans- e pós-operatórios. O grupo A (n = 44) incluiu pacientes submetidos ao tratamento conservador-desbridamento associado a ressutura e/ou a irrigação contínua com solução de polivinilpirrolidona-iodo, ou ainda a cicatrização por segunda intenção (dados retrospectivos). O grupo B (n = 9) incluiu pacientes nos quais não houve resolução da infecção com o tratamento conservador e que, por isso, foram submetidos ao tratamento agressivo (fase intermediária). O grupo C (n = 28) incluiu pacientes submetidos primariamente ao tratamento agressivo (dados prospectivos). RESULTADOS: Identificou-se menor tempo de internação pós-operatória nos pacientes submetidos ao tratamento agressivo (p < 0,046). Houve 7 óbitos no grupo A, 1 no grupo B e 2 no grupo C. Entretanto, o nível de significância clássico de α = 0,05 não foi atingido. CONCLUSÕES: O tratamento agressivo mostrou-se também adequado para aquelas infecções em que o tratamento conservador não foi resolutivo. Esses achados demonstram que o tratamento proposto tem excelentes resultados.

show abstract

Suppurative Mediastinitis after Open Heart Surgery

Cited by 92 publications

References 32 publications

Mediastinitis after Cardiac Surgery: Improvement of Bacteriological Diagnosis by Use of Multiple Tissue Samples and Strain Typing

Mediastinitis after Cardiac Surgery: Improvement of Bacteriological Diagnosis by Use of Multiple Tissue Samples and Strain Typing

Does gender predict development of mediastinitis?

Tratamento agressivo com retalho muscular e/ou omentopexia nas infecções do esterno e mediastino anterior em pós-operatório de esternotomia

Contact Info

Product

Resources

About