Mediastinal infection after cardiac operation

Durandy, Yves; Batisse, A; Bourel, Patrick; Dibié, Alain; Lemoine, G; Lecompte, Y

doi:10.1016/s0022-5223(19)35336-x

Cited by 68 publications

(33 citation statements)

References 6 publications

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“…Brandt 20 has emphasized the importance of “immediate and thorough sternal debridement” to prevent progressive infection involving the deeper structures. Since the early period of cardiac surgery, a variety of techniques, such as open continuous irrigation, 21 redon catheters for vacuum drainage, 22 debridement, antibiotics, open packing, and delayed closure 23 have been used for the management of the sternal osteomyelitis. However, open wound dressing changes are uncomfortable for patients and time‐consuming for the staff, and it carries the risk of super infection and fatal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Management of Intractable Sternal Wound Infections with Topical Negative Pressure Dressing

Lee¹,

Lin

Chen³

et al. 2005

Journal of Cardiac Surgery

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The advantages of applying TNP dressings in cases of intractable sternal wound infections include (1) protecting the underlying mediasternal structure from infection, (2) permitting delayed sternal closure to avoid cardiac compression induced compromised cardiopulmonary function, (3) possibility of repeated wound inspection and bedside debridement, (4) cost-effectiveness of wound care, and (5) providing an option to promote sternal wound secondary healing for patients in poor physical condition.

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Section: Discussionmentioning

confidence: 99%

Management of Intractable Sternal Wound Infections with Topical Negative Pressure Dressing

Lee¹,

Lin

Chen³

et al. 2005

Journal of Cardiac Surgery

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“…The median time from the initial surgery to mediastinitis debridement was 14 (10-21) days for the survivors and 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days for the non-survivors (p 0.066).…”

Section: Gnbm Outcomementioning

confidence: 99%

“…Subsequently, any fibrin deposits were removed and necrotized areas of the sternum were resected. As previously described [7,8], three to ten Redon catheters for aspirating drainage were inserted in infected areas, including the mediastinal cavity and dissected subcutaneous chest wall area. Each catheter was connected to a bottle in which a negative pressure was maintained (Drainobag â 150; B. Braun Melsungen AG, Melsungen, Germany).…”

Section: Patient Managementmentioning

confidence: 99%

“…Mediastinitis is a severe complication of cardiac surgery, occurring in 0.25-2.9% of patients with sternotomy [1][2][3][4][5]. Although aggressive treatments including early surgical debridement and closed aspirative catheter drainage have dramatically improved the outcome, the mortality rate remains high (7-40%) [3,[6][7][8][9]. Epidemiological data of mediastinitis have been reported in previous studies [1,2,10,11], but only a few studies have investigated prognostic factors, mainly related to intraoperative events [3,12].…”

Section: Introductionmentioning

confidence: 99%

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Mediastinitis due to Gram-negative bacteria is associated with increased mortality

Charbonneau

Maillet

Faron

et al. 2014

Clinical Microbiology and Infection

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The aim of this study was to describe the features of a large cohort of patients with postoperative mediastinitis, with particular regard to Gram-negative bacteria (GNB), and assess their outcome. This bicentric retrospective cohort included all patients who were hospitalized in the Intensive Care Unit with mediastinitis after cardiac surgery during a 9-year period. Three hundred and nine patients developed a mediastinitis with a mean age of 65 years and a mean standard Euroscore of six points. Ninety-one patients (29.4%) developed a GNB mediastinitis (GNBm). Of the 364 pathogens involved, 103 GNB were identified. GNBm were more frequently polymicrobial (44% versus 3.2%; p <0.001). Being female was the sole independent risk factor of GNBm in multivariate analysis. Initial antimicrobial therapy was significantly more frequently inappropriate with GNBm compared with other microorganisms (24.6% versus 1.9%; p <0.001). Independent risk factors for inappropriateness of initial antimicrobial treatment were GNBm (OR = 8.58, 95%CI 2.53-29.02, p 0.0006), and polymicrobial mediastinitis (OR = 4.52, 95%CI 1.68-12.12, p 0.0028). GNBm were associated with more drainage failure, secondary infection, need for prolonged mechanical ventilation and/or use of vasopressors. Thirty-day hospital mortality was significantly higher with GNBm (31.9 % versus 17.0%; p 0.004). GNBm was identified as an independent risk factor of hospital mortality (OR = 2.31, 95%CI 1.16-4.61, p 0.0179).

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“…The use of NPWT in DSWI has shown clinical promise through its use as a bridge to direct or flap closure in a number of publications. [5][6][7][8][9][10][11][12][13][14][15] Outcomes in determining the advantages of this management adjunct should include number of days to definitive wound closure along with length of hospital stay, number of dressing changes or returns to the operating theatre for debridement or dressing changes, need for flap reconstruction as well as general morbidity and mortality.…”

Section: Anzjsurgcommentioning

confidence: 99%