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Sequential antimicrobial therapy in mediastinitis after cardiac surgery: An observational study of 81 cases
Joffrey Eduardo Luján-Valencia1, Luis Eduardo López-Cortes2, Román Calvo-Jambrina1
1Cardiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
Introduction:
Mediastinitis is an infrequent but serious complication of cardiac surgery. Antimicrobial treatment guidelines are not well established. The aim was to describe the efficacy of sequential intravenous to oral therapy in selected post-surgical mediastinitis patients.
Methods:
A retrospective observational study including cases of mediastinitis after cardiac surgery, defined according to CDC criteria, at a third-level university hospital between January 2002 and December 2016. Sequential antimicrobial therapy was proposed in clinically stable patients. Rates of cure, relapse, and hospital stay were compared between patients who received sequential intravenous to oral therapy and those who received therapy exclusively by the intravenous route.
Results:
Eighty-one cases were included. Sequential intravenous to oral therapy was performed in 48 (59.3%) patients on median day 15. No differences in baseline characteristics or causal microorganisms were found between the two cohorts. The average duration of antibiotic therapy was 41.2±10.09 days. The most commonly used drugs in sequential therapy were quinolones in 31 (64.6%) cases and rifampicin, always in association with another antibiotic, in 25 (52.1%). Hospital stay was shorter in the sequential therapy group (57.57±34.03 vs. 84.35±45.67; P=0.007). Cure was achieved in 77 (92.8%) patients. Overall in-hospital mortality was less frequent in the group that received sequential therapy (2.1% vs. 15.2%; P=0.039). There were no differences in relapse between the two cohorts (4.2% vs 9.1%; P=0.366).
Conclusion:
Sequential antimicrobial treatment in selected patients with post-surgical mediastinitis may be as effective as exclusively intravenous treatment, reducing risks, hospital stay and associated costs.
Insights
Sequential therapy for post-surgical mediastinitis is effective. This approach, transitioning from intravenous to oral antibiotics, reduced hospital stays and mortality compared to exclusively intravenous treatments, with similar cure rates.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Mediastinitis is a rare but severe complication following cardiac surgery.
- Established antimicrobial treatment guidelines for mediastinitis are lacking.
- This study evaluates sequential intravenous to oral therapy for post-surgical mediastinitis.
Purpose of the Study:
- To assess the efficacy of sequential intravenous to oral antimicrobial therapy in selected patients with post-surgical mediastinitis.
- To compare cure rates, relapse rates, and hospital stay duration between sequential and exclusively intravenous treatment groups.
Main Methods:
- Retrospective observational study of 81 patients with post-surgical mediastinitis (2002-2016).
- Patients were categorized based on receiving sequential intravenous to oral therapy or exclusively intravenous therapy.
- Outcomes analyzed included cure, relapse, hospital stay, and mortality.
Main Results:
- Sequential therapy was administered to 48 patients, starting median day 15.
- The sequential therapy group experienced significantly shorter hospital stays (57.57 vs. 84.35 days) and lower in-hospital mortality (2.1% vs. 15.2%).
- Cure rates were high in both groups (92.8% overall), with no significant difference in relapse rates.
Conclusions:
- Sequential intravenous to oral antimicrobial therapy is a viable and effective option for selected post-surgical mediastinitis patients.
- This approach can reduce hospital length of stay and mortality risks.
- Sequential therapy offers comparable efficacy to exclusively intravenous treatment with potential benefits in resource utilization.
