Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center
Angela De Palma1, Mirko Girolamo Cantatore1, Francesco Di Gennaro2
1Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy.
Abstract:
Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo's classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.
Insights
Descending necrotizing mediastinitis (DNM) management requires prompt diagnosis and a multidisciplinary approach. Combining surgical drainage with appropriate antimicrobial therapy is crucial for reducing mortality and morbidity in this severe condition.
Area of Science:
- Medicine
- Surgery
- Infectious Diseases
Background:
- Descending necrotizing mediastinitis (DNM) is a rare, severe infection with high mortality.
- Optimal management strategies for DNM remain debated.
- Early diagnosis and intervention are critical for patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary management protocol for DNM.
- To analyze patient outcomes, complications, and mortality associated with DNM treatment.
Main Methods:
- Retrospective analysis of 15 male patients treated for DNM over 20 years.
- Multidisciplinary approach including cervicotomy, thoracotomy for drainage, and antimicrobial therapy.
- Classification of DNM using Endo's criteria.
Main Results:
- No post-operative mortality observed in the study cohort.
- Common pathogens included Staphylococci, Candida, and polymicrobial infections.
- Cardiovascular disease was linked to longer hospital stays and chest tube duration.
Conclusions:
- A multidisciplinary strategy combining surgical drainage and targeted antimicrobial therapy is effective for DNM.
- Prompt diagnosis and treatment are essential to improve survival and reduce complications.
- Further research may explore risk factors and optimize treatment protocols for DNM.
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