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Suppurative mediastinitis after open-heart surgery: a comparison between cases caused by Gram-negative rods and by

M. J. Rodríguez-Hernández1, A. de Alarcón, J. M. Cisneros

  • 1Infectious Diseases Unit.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|January 1, 1997
PubMed

Insights

Suppurative postsurgical mediastinitis risk factors were analyzed. Gram-negative rod infections, often linked to remote site infections, were associated with worse outcomes and longer mechanical ventilation.

Area of Science:

  • Medicine
  • Infectious Diseases
  • Surgery

Background:

  • Suppurative postsurgical mediastinitis is a serious complication following open-heart surgery.
  • Understanding the etiological factors is crucial for improving patient outcomes.

Purpose of the Study:

  • To compare the clinical characteristics and risk factors of suppurative postsurgical mediastinitis based on its causative agents.
  • To identify differences between Gram-negative and Gram-positive infections.

Main Methods:

  • A retrospective study of 1779 patients undergoing open-heart surgery between 1986 and 1996.
  • Analysis of 45 cases of suppurative postsurgical mediastinitis, with microbiological data available for 42 patients.
  • Comparison of clinical characteristics and outcomes between patients with Gram-negative rod infections and Gram-positive cocci infections.

Main Results:

  • Gram-negative rods were identified in 19 cases, and Gram-positive cocci in 23 cases.
  • Patients with Gram-negative infections experienced longer bypass durations (127±36 min vs. 96±34 min) and poorer postoperative conditions.
  • Longer mechanical ventilation (4±7 days vs. 1±2 days) and higher rates of concomitant remote-site infections (58% vs. 22%) were observed in the Gram-negative group.
  • Bacteremia occurred in 51% of patients, with an overall mortality rate of 20%.

Conclusions:

  • Preventable postoperative remote-site infections may contribute to the development of mediastinitis.
  • Gram-negative rod involvement in postsurgical mediastinitis is associated with more severe clinical presentations and poorer outcomes.
  • Targeted antimicrobial strategies and infection control measures are essential, particularly for Gram-negative infections.

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