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Gram-negative bacteria as a cause of mediastinitis after cardiac surgery

Maddalena Peghin1, Esmeralda Pompei2, Igor Vendramin2

  • 1Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Friuli Centrale (ASUFC).

Current Opinion in Infectious Diseases
|October 15, 2021
PubMed
Abstract

Insights

Gram-negative bacteria (GNB) are an underestimated cause of poststernotomy mediastinitis (PSM), leading to higher mortality. Improved knowledge on GNB PSM risk factors, diagnosis, and treatment is crucial for better patient outcomes.

Area of Science:

  • Infectious Diseases
  • Cardiothoracic Surgery
  • Microbiology

Background:

  • Poststernotomy mediastinitis (PSM) is a severe complication of cardiac surgery.
  • Gram-negative bacteria (GNB) are an underrecognized cause of PSM, associated with significant morbidity and mortality.
  • Limited information exists on the specific risk factors, prevention, diagnosis, and management of GNB-induced PSM.

Purpose of the Study:

  • To review and highlight the underappreciated role of Gram-negative bacteria (GNB) in poststernotomy mediastinitis (PSM).
  • To discuss the current understanding of GNB PSM pathogenesis, clinical presentation, and epidemiological data.
  • To emphasize the need for improved strategies for the prevention, diagnosis, and management of GNB PSM.

Main Methods:

  • Literature review of studies focusing on Gram-negative bacteria in poststernotomy mediastinitis.
  • Analysis of data on risk factors, causative pathogens, and treatment outcomes for GNB PSM.
  • Synthesis of current evidence regarding diagnostic approaches and therapeutic interventions for GNB PSM.

Main Results:

  • GNB account for 18-38% of PSM cases and are frequently associated with polymicrobial infections.
  • GNB PSM tends to present earlier and is associated with higher mortality compared to Gram-positive causes.
  • Inappropriate initial antibiotic therapy is a significant factor contributing to the worse outcomes in GNB PSM.

Conclusions:

  • Gram-negative bacteria are a frequent and serious cause of PSM, often underestimated.
  • Early diagnosis and appropriate, culture-directed antimicrobial therapy combined with surgical debridement are essential for managing GNB PSM.
  • Further research and clinical efforts are needed to enhance the prevention and treatment of GNB PSM.

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