Defining post-sternotomy mediastinitis for clinical evidence-based studies

Wingerden, Jan J. van; Mol, Bas A.J.M. de; Horst, Chantal M.A.M. van der

doi:10.1177/0218492316639405

Cited by 10 publications

(4 citation statements)

References 65 publications

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“…Considering the multitude of possible presentations of wound infections post-sternotomy, the first step in our analysis was to extract proper definitions and classifications from the analyzed publications. DSWI can involve the skin, subcutaneous tissue, and eventually bone, with heterogeneous definitions in the literature [8]. The following classification, which was presented by Rupprecht and Schmid [9], addresses appropriate treatment according to clinical findings.…”

Section: Resultsmentioning

confidence: 99%

Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery

et al. 2019

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Median sternotomy is the most popular approach in cardiac surgery. Post-sternotomy wound complications are rare, but the occurrence of a deep sternal wound infection (DSWI) is a catastrophic event associated with higher morbidity and mortality, longer hospital stays, and increased costs. A literature review was performed by searching PubMed from January 1996 to August 2017 according to the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The following keywords were used in various combinations: DSWI, post-sternotomy complication, and sternal reconstruction. Thirty-nine papers were included in our qualitative analysis, in which each aspect of the DSWI-related care process was analyzed and compared to the actual standard of care. Plastic surgeons are often involved too late in such clinical scenarios, when previous empirical treatments have failed and a definitive reconstruction is needed. The aim of this comprehensive review was to create an up-to-date operative flowchart to prevent and properly treat sternal wound infection complications after median sternotomy.

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Section: Resultsmentioning

confidence: 99%

Deep sternal wound infections: Evidence for prevention, treatment, and reconstructive surgery

et al. 2019

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“…Inclusion criteria were: patient over 18 years of age; patient undergoing cardiac or ascending aorta surgery with sternotomy; occurrence of a post-sternotomy mediastinitis according to the Amsterdam consensus definition and formal identification of a fungus within the surgical site [8]. Post-sternotomy mediastinitis was defined as an infection occurring within one year (regardless of whether an implant is in place or not), and infection appearing related to the operative procedure, with at least one of the following criteria: (1) patient has microorganisms cultured from mediastinal tissue or fluid obtained during a surgical operation or needle aspiration, (2) patient has evidence of mediastinitis confirmed during a surgical operation or histopathological examination, (3) patient has at least one of the following signs or symptoms with no other recognized cause: fever (> 38 °C), chest pain or sternal instability; (4) at least one of the following: purulent discharge from mediastinal area, organisms cultured from blood or discharged from mediastinal area, radiological evidence of an infective process in the mediastinum.…”

Section: Patientsmentioning

confidence: 99%

“…Five patients were supported with LVAD and five by peripheral VA-ECMO before initial surgery. The preoperative Euroscore II was 11.8 [4.2-21.2] % and initial ICU admission SOFA score was 9 [5][6][7][8][9][10]. Eighteen patients underwent coronary artery bypass graft (CABG) or valve replacement surgery, and 12 heart transplantation.…”

Section: Patient's Characteristicsmentioning

confidence: 99%

“…7 CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine, 54000 Nancy, France. 8 Service d'anesthésie-réanimation, CHU de Rennes, 35000 Rennes, France. 9 CHU de Rennes, Inra, Inserm, Institut NUMECAN -UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d'Investigation Clinique de Rennes), Univ Rennes, 35000 Rennes, France.…”

Section: Abbreviationsunclassified

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Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome

et al. 2023

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Objectives The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. Methods Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009–2019). Results Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17–61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43–65] vs. 65 [61–73] yo; p = 0.013), had lower body mass index (24 [20–26] vs. 30 [24–32] kg/m2; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28–40] vs. 54 [34–61]; p = 0.012). Conclusion Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.

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