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Staphylococcus aureus mediastinitis: prognostic usefulness of an early medicosurgical therapy
P Voiriot1, J A Marcoux, R Duperval
1Department of Medicine, University of Sherbrooke School of Medicine, Québec, Canada.
Abstract:
Six cases of acute Staphylococcus aureus mediastinitis after median sternotomy were reported. Five resulted from an asymptomatic disseminator of S aureus present in the operating room. Each case was characterized by an acute bacteremic phase, occurring after a mean interval of 8.2 +/- 1.7 days after the surgical procedure; within 24 to 36 hours all patients had a temperature above 39 degrees C, toxic appearance, and marked leukocytosis. Pericicatricial inflammation was moderate, instability of the sternum was present in only two patients, and chest roentgenogram was not helpful in making an early diagnosis. No risk factor for mediasinitis in connection with the perioperative or postoperative periods was noted in cases compared with a control group of 103 patients. All strains of S aureus were susceptible in vitro to the antibiotic regimen used in prophylaxis. All patients underwent early surgical reopening of the mediastinum within 47 +/- 15 hours after the first sign of acute mediastinitis. Mediastinal debridement and continuous irrigation-suction with dilute povidone-iodine solution were associated with intravenous antistaphylococcal therapy for a period of four to six weeks. All patients survived and no recurrence was observed, a finding we think due to early diagnosis and aggressive medicosurgical therapy.
Insights
Acute Staphylococcus aureus mediastinitis following median sternotomy can be effectively treated. Early diagnosis and aggressive surgical intervention, combined with antibiotic therapy, led to survival in all reported cases.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Cardiothoracic Surgery
Background:
- Acute Staphylococcus aureus mediastinitis is a rare but serious complication after median sternotomy.
- Infection often originates from an asymptomatic carrier in the operating room environment.
- Standard diagnostic methods like chest X-rays may not be helpful in early detection.
Purpose of the Study:
- To report on six cases of acute Staphylococcus aureus mediastinitis post-median sternotomy.
- To analyze the clinical presentation, diagnostic challenges, and treatment outcomes.
- To emphasize the importance of early diagnosis and aggressive management.
Main Methods:
- Case series reporting six patients with acute Staphylococcus aureus mediastinitis.
- Analysis of clinical data, including onset of symptoms, diagnostic findings, and treatment protocols.
- Comparison with a control group of 103 patients to identify risk factors.
Main Results:
- Five cases were linked to an asymptomatic Staphylococcus aureus carrier in the operating room.
- Patients presented with fever, toxic appearance, and leukocytosis 8.2 days post-surgery.
- Early surgical reopening, debridement, irrigation-suction, and intravenous antibiotics were employed.
- All patients survived without recurrence, despite initial diagnostic challenges.
Conclusions:
- Acute Staphylococcus aureus mediastinitis requires prompt recognition and intervention.
- Aggressive medicosurgical therapy, including debridement and antibiotics, is crucial for survival.
- Early diagnosis and treatment are key to successful outcomes in these severe infections.