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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.
Abstract:
OBJECTIVE: To compare clinical characteristics and risk factors of suppurative postsurgical mediastinitis according to its etiology. METHODS: Suppurative postsurgical mediastinitis developed in 45 (2.5%) of 1779 patients who underwent open-heart surgery at the Hospital Virgen del Rocío in Seville, Spain, from 1986 to 1996. Microbiological diagnosis was available in 42 patients. RESULTS: Gram-negative rods were isolated in 19 cases and Gram-positive cocci in 23 cases. Seventeen isolates (38%) were sensitive to the antimicrobial agent used perioperatively. Patients with Gram-negative rod infection had a longer duration of bypass (127plus minus36 min versus 96plus minus34 min, p<0.01), and a worse postoperative condition. Longer mechanical ventilation (4plus minus7 days versus 1plus minus2 days, p<0.05) and concomitant infection in a remote site (pulmonary and/or urinary infection) were more frequently observed in this group than in patients with Gram-positive infections (58% versus 22%, p<0.05). Twenty patients (51%) were bacteremic. The mortality rate was 20% (five of 45). CONCLUSIONS: Preventable postoperative remote-site infection may lead to mediastinitis, especially if Gram-negative rods are involved.
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.