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[Mediastinitis after cardiac surgery. A 10-year evaluation (1985-1995)]
J Valla1, H Corbineau, T Langanay
1Clinique Montlouis, Paris.
Insights
Mediastinitis following cardiac surgery is a serious complication. This study found a decrease in mediastinitis rates with improved antibiotic prophylaxis and patient care, highlighting mechanical ventilation duration as a key risk factor.
Area of Science:
- Cardiovascular Surgery
- Infectious Disease Epidemiology
- Critical Care Medicine
Context:
- Cardiac surgery involving cardiopulmonary bypass carries a risk of mediastinitis.
- A decade of data (1985-1995) from 9,814 patients undergoing cardiac procedures was analyzed.
- Changes in antibiotic prophylaxis and patient demographics were noted between two study periods.
Purpose:
- To investigate the incidence and risk factors of mediastinitis after cardiac surgery.
- To evaluate the impact of changes in antibiotic prophylaxis (Cefuroxime vs. Cefamandole) on mediastinitis rates.
- To identify risk factors associated with mediastinitis and mortality post-cardiac surgery.
Summary:
- Mediastinitis occurred in 66 patients (0.67%), with a significant decrease observed in the latter half of the study period (p < 0.001).
- Staphylococcus was the predominant pathogen; Gram-negative infections decreased in the second period.
- Key risk factors for mediastinitis included male gender, emergency surgery, diabetes, obesity, redo procedures, longer cardiopulmonary bypass times, and prolonged mechanical ventilation (>48 hours).
- Mortality rate was 39.4%, with advanced age, female gender, poor constitution, and high cardio/thoracic ratio (>0.55) identified as mortality risk factors.
Impact:
- The findings suggest that optimized antibiotic prophylaxis and targeted patient care strategies can reduce mediastinitis incidence.
- Identifying high-risk patients allows for the implementation of specific preoperative measures to prevent complications.
- For patients developing mediastinitis requiring debridement, considering cover procedures is crucial, especially for the elderly or those in poor health.
Unlabelled:
From June 1985 to May 1995, 9,814 patients were operated for a cardiac procedure with cardiopulmonary by-pass. Mean age was 61,3 years. The most frequent procedure was coronary surgery (45%), followed by valvular surgery (34%) then combined surgery (11%) and other surgery (4%). 66 cases of mediastinitis were observed: 38 from June 1985 to May 1990 (first group), 28 from June 1990 to May 1995 (second group). The changes between the two groups was antibiotic prophylaxis using Cefuroxime in the first group and Cefamandole in the second and also an impairment of general status of the patients in the second group. Staphylococcus remains the most frequent organism in both groups and for Gram negative bacteria was less frequent in the second group. Several risks factors mediastinitis were identified (males, emergency, diabetes mellitus, obesity, redo, patient of first group, duration of Cardiopulmonary by pass for 100 minutes, mechanical ventilation greater than 48 hours) and the most important factor was the need for mechanical ventilation for more than 48 hours. The mortality rate was 39.4% (26 patients). Identified risk factors of mortality were age over 65 years, females, poor constitution, and cardio/thoracic ratio > 0.55.
Conclusion:
Mediastinitis after cardiac surgery remains a serious complication. In this series we observed a decrease of mediastinitis rates, especially in the second group (p < 0.001). In high risk patients, specific preoperative methods of patient care may be able to prevent such complications. When mediastinitis appears, and when debridement is necessary, a cover procedure seems necessary in elderly or poor constitution patients.