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Mediastinitis due to Gram-negative bacteria is associated with increased mortality
H Charbonneau1, J M Maillet, M Faron
1Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France.
Summary
Gram-negative bacteria (GNB) significantly increase the risk and mortality of postoperative mediastinitis in cardiac surgery patients. Inappropriate initial treatment for GNB mediastinitis (GNBm) is common and linked to worse outcomes.
Area of Science:
- Medicine
- Infectious Diseases
- Critical Care Medicine
Background:
- Postoperative mediastinitis is a serious complication following cardiac surgery.
- Gram-negative bacteria (GNB) are increasingly recognized pathogens in healthcare-associated infections.
Purpose of the Study:
- To characterize Gram-negative bacteria mediastinitis (GNBm) in cardiac surgery patients.
- To identify risk factors for GNBm and assess its impact on patient outcomes and mortality.
Main Methods:
- Retrospective cohort study of 309 patients with mediastinitis after cardiac surgery over 9 years.
- Analysis of pathogen identification, clinical features, treatment appropriateness, and mortality.
- Multivariate analysis to identify independent risk factors.
Main Results:
- Gram-negative bacteria (GNB) caused 29.4% of mediastinitis cases (GNBm).
- GNBm was more frequently polymicrobial and associated with inappropriate initial antimicrobial therapy (24.6% vs 1.9%).
- Female sex was the sole independent risk factor for GNBm; GNBm independently increased hospital mortality (OR = 2.31).
Conclusions:
- Gram-negative bacteria mediastinitis presents unique challenges, including higher rates of polymicrobial infection and inappropriate initial treatment.
- Prompt and appropriate antimicrobial therapy is crucial for improving outcomes in patients with GNBm.
- GNBm is a significant independent risk factor for mortality in postoperative mediastinitis.
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