Mediastinite aguda: análise retrospectiva de 21 casos

Abstract

Objective: To evaluate the epidemiological and clinical aspects of acute mediastinitis and to characterize its treatment. Methods: A retrospective study conducted through review of the medical charts of patients diagnosed with acute mediastinitis at the Hospital Escola da Faculdade de Medicina do Triângulo Mineiro (Triângulo Mineiro Medical School Hospital) between 1987 and 2004. Results: A total of 21 patients were studied. Most (76.2%) were male, and the mean age was 52.5 years. Six patients (28.6%) died. The most common cause (in 38.1%) was median sternotomy, followed by esophageal perforation (in 33.3%) and cervical infection (in 14.3%). Staphylococcus aureus and Staphylococcus epidermidis were the causative agents most frequently isolated. In most cases, the treatment of choice was antibiotic therapy accompanied by surgery. The most frequent complications of the acute mediastinitis were pleural effusions (in 23.8%) and osteomyelitis (in 19.0%). The average hospital stay was 26.6 days. Conclusion: Acute mediastinitis is a serious complication of some diseases and procedures. Despite its low incidence, the mortality rate is high. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative agents. The treatment used was antibiotic therapy accompanied by surgery.

Mediastinite pós-cirúrgica em um Hospital Cardiológico de Recife: contribuições para a assistência de enfermagem

“…It is defined as an infection and/or inflammation of joint tissue in the mediastinum, associated with sternal osteomyelitis, with or without instability, and may even reach the retrosternal space (2,(3)(4) . It can be caused by medium sternotomy (5)(6) , esophageal rupture (7)(8) , deep cervical infections and, rarely, by pleural empyema, vertebral or costal osteomyelitis, retroperitoneal and subphrenic abscesses (4)(5)9) .…”

Manuseio em um estágio de esternotomia infectada com avanço bilateral de flap miocutâneo do peitoral maior

“…It is, however, contraindicated in case of hemodynamic instability and surgical site infection, as reported previously [21]. The risk factors in mediastinitis BRITO, JD ET AL -One-stage management of infected sternotomy wounds using bilateral pectoralis major myocutaneous advancement flap Rev Bras Cir Cardiovasc 2009; 24 (1): [58][59][60][61][62][63] have been reported frequently, for which we must be careful and make the necessary prevention [17][18][19].…”

“…Due to the importance of this type of complication, this issue has attracted cardiovascular and plastic surgeons, for over forty years [1][2][3][10][11][12][13][14][15][16][17][18][19][20]. In our institution, since 1986, we began to treat -consecutively -the sternal wound infection (with debridement, wide drainage and immediate closure) with bilateral pectoralis major myocutaneous advancement flap, whose initial results were published in 1993 [21].…”

Profilaxia Com Mupirocina Em Pacientes Submetidos À Esternotomia Para Cirurgia Cardíaca No Paraná

“…5 As principais causas relacionadas à mediastinite são: esternotomia mediana; principalmente realizada para cirurgia cardíaca; ruptura de esôfago, abcessos de cabeça e pescoço, empiema pleural, osteomielite de vértebras e costelas, e abcessos retroperitoneais e subfrênicos. 6 Apesar da incidência ser baixa e representar cerca de 0,2% a 5% das infecções, esta afecção apresenta alto índice de morbidade e mortalidade, com taxas que ultrapassam o valor de 40% de óbitos. Os riscos de mediastinite são maiores quando associados a condições como: diabetes mellitus, doença pulmonar obstrutiva crônica, tabagismo, corticoterapia, ventilação mecânica, entre outras.…”

“…e a Escherichia coli. Muitas vezes a cultura pode apresentar-se negativa para a presença de microorganismos, isto se deve ao uso de antibióticos profiláticos, 6 como é o caso da mupirocina, um antibiótico tópico que parece ser eficaz na profilaxia desta patologia. 9 Além de reduzir a morbimortalidade, o uso da mupirocina reduz os custos hosptalares com o internamento do paciente, tendo em vista que reduz o número de infecções.…”