Postsurgical Mediastinitis: A Case‐Control Study

Muñóz, Patricia; Menasalvas, Ana; Quirós, Juan Carlos López Bernaldo de; Desco, Manuel; Vallejo, José Luis; Bouza, Emilio

doi:10.1086/516068

Cited by 107 publications

(51 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings are in agreement with those of other studies of postsurgical mediastinitis (7,13). Coagulase-negative Staphylococcus was the main organism isolated from EPW cultures (74.9%).…”

Section: Discussionsupporting

confidence: 92%

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Mekontso-Dessap

Honore²,

Kirsch

et al. 2004

J Clin Microbiol

View full text Add to dashboard Cite

Poststernotomy mediastinitis (PSM) is one of the most serious complications of cardiac surgery, and its associated morbidity and mortality demand early recognition for emergency therapy. In this study, we investigated the usefulness of epicardial pacing wire (EPW) cultures for the prediction of PSM. Among 2,200 patients who underwent a cardiac surgical procedure at our hospital between 1 January 1999 and 31 December 2001, 82 (3.7%) had PSM; Staphylococcus aureus was the organism (45.1%) most frequently isolated at the time of surgical debridement. EPWs from 1,607 (73.0%) patients, 73 (4.5%) of whom developed PSM, were cultured. EPW cultures from 466 (29.0%) were positive, most often (74.9%) for coagulase-negative Staphylococci. EPW cultures were truly positive in 26 cases, truly negative in 1,106 cases, falsely positive in 428 cases, and falsely negative in 47 cases (with sterile cultures in 35 cases and a culture positive for an organism different from that isolated at the time of debridement in 12 cases). EPW culture had a positive predictive value of only 5.7% and a high negative predictive value (95.9%) for the diagnosis of PSM, with an accuracy of 70.4%. However, the likelihood ratio of positive (1.27) and negative (0.89) tests indicated only small changes in pretest-to-posttest probability. Therefore, a strategy of routine culture of EPWs to predict PSM seems questionable.Poststernotomy mediastinitis (PSM) is a life-threatening complication that occurs in about 1 to 5% of cardiac surgery procedures. PSM is associated with major patient morbidity, mortality, and cost (11). Successful management of this infection requires early diagnosis and aggressive treatment (5). In fact, the prognosis for patients with PSM appears to be related to the length of time required for the institution of treatment (4). The diagnosis of PSM is sometimes straightforward, and it is established by physical examination of the wound and by conventional laboratory studies. However, diagnosis in the early stages where treatment is the most effective is often difficult, and multiple diagnostic procedures are sometimes necessary to ascertain the infectious process.Epicardial pacing wires (EPWs) are fixed in the pericardium at the end of cardiac surgery procedures to treat postoperative bradyarrythmias. Some authors have suggested that EPW cultures might be helpful in the early diagnosis of PSM (2,8,12). However, these studies included only a small number of patients with PSM (35 patients in all). The present study was undertaken to evaluate our strategy of routine EPW culture and its contribution to identification of PSM at an early stage. MATERIALS AND METHODS Study population.All patients who underwent a cardiac surgical procedure via median sternotomy between 1 January 1999 and 31 December 2001 at Henri Mondor University Hospital (Créteil, France) were studied. Body hair was removed the day before operation with a clipper. Patients showered the night and morning before surgery with a povidone-iodine solution (or chlorhexidine in case...

show abstract

Section: Discussionsupporting

confidence: 92%

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Mekontso-Dessap

Honore²,

Kirsch

et al. 2004

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…Those often include purulent discharge from the mediastinal area (11,12,16), in some cases together with fever (Ն38°C) and sternal dehiscence (4,10,18). L'Ecuyer et al, who did not include purulent discharge or sternal dehiscence in their criteria for chest infection, found that those signs occurred in only 67% and 26% of the patients, respectively (8).…”

mentioning

confidence: 99%

Mediastinitis after Cardiac Surgery: Improvement of Bacteriological Diagnosis by Use of Multiple Tissue Samples and Strain Typing

Tammelin¹,

Hambræus²,

Ståhle

2002

J Clin Microbiol

View full text Add to dashboard Cite

The diagnosis of postsurgical mediastinitis (PSM) among patients with sternal wound complication (SWC) after cardiac surgery is sometimes difficult, as fever, elevated C-reactive protein levels, and chest pain can be caused by a general inflammatory reaction to the operative trauma and/or sternal dehiscence without infection. The definitions of PSM usually used emphasize clinical signs and symptoms easily observed by the surgeon. The aim of the study was to investigate whether the use of standardized multiple tissue sampling, optimal culturing methods, and strain typing, together with a microbiological criterion for infection, could identify more infected patients than clinical assessment alone. Patients reexplored due to SWC after cardiac artery bypass grafting (CABG) or heart valve replacement (HVR) with or without CABG performed at the Department for Cardio-Thoracic Surgery at the Uppsala University Hospital between 10 March 1998 and 9 September 2000 were investigated prospectively. Tissue samples were taken from the sternum or adjacent mediastinal tissue, preferably before the administration of antibiotics. Culturing was performed both directly (on agar plates) and using enrichment broth. Species identification was performed by standard methods, and strain typing was performed by pulsed-field gel electrophoresis. A total of 41 cases with at least five tissue samples each were included in the study group. Of these patients, 32 were infected according to the microbiological criterion (i.e., the same strain was found in >50% of the samples). Staphylococcus epidermidis was the primary pathogen in 38% of the cases (12/32), S. aureus was the primary pathogen in 31% (10/32), P. acnes was the primary pathogen in 25% (8/32), and S. simulans and S. haemolyticus were the primary pathogens in 3% (1/32) each. All cases of S. aureus infection and 86% (12/14) of coagulase-negative staphylococcus (CoNS) infections were identified from primary cultures. All cases fulfilling the microbiological criterion for S. aureus infection were clinically diagnosed as cases of infection, but among the 14 cases fulfilling the criterion for microbiological diagnosis of CoNS infection, only 10 appeared to qualify clinically as cases of infection. Among the patients with sternal dehiscence in whom a microbiological diagnosis was established, 67% (12/18) had a CoNS infection, compared to 14% (2/14) of those without sternal dehiscence. The difference was statistically significant. PSM caused by S. aureus is readily identified by the surgeon, whereas 30% of cases with CoNS infections may be misinterpreted as noninfected. Multiple sampling before administration of antibiotics, primary culturing on agar plates, species identification, strain typing, and susceptibility testing should be used to ensure a fast and microbiologically correct diagnosis which identifies the primary pathogen and infected patients among those with minor infective symptoms. The role of P. acnes as a possible cause of PSM needs further investigation. PSM caused by CoNS is s...

show abstract

“…aeruginosa. [7][8][9] So our regime of antibiotics containing teicoplanin and meropenem was justified to use as prophylaxis of all types of open Heart surgery. Glycopeptides have some adverse events particularly 'red man' syndrome and nephrotoxicity.…”

Section: Antibiotic Regimementioning

confidence: 99%

“…3,4 Staphylococcus aureus and Staphylococcus epidermidis are the most common culprit in post cardio-thoracic SSI. [5][6][7][8][9] Other micro-organisms, including diptheroides, aerobic and anaerobic streptococci and enteric gram-negative bacilli are also involved. [10][11][12] In an attempt to prevent both wound infections and prosthetic valve endocarditis cardiac surgery presently administer antibiotics to virtually all patients undergoing cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Teicoplanin and Meropenem Prophylaxis in Open Heart Surgery- Efficacy and Safety

Sarker

Biswas

et al. 2017

Cardiovasc. j.

View full text Add to dashboard Cite

show abstract

Postsurgical Mediastinitis: A Case‐Control Study

Cited by 107 publications

References 18 publications

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Usefulness of Routine Epicardial Pacing Wire Culture for Early Prediction of Poststernotomy Mediastinitis

Mediastinitis after Cardiac Surgery: Improvement of Bacteriological Diagnosis by Use of Multiple Tissue Samples and Strain Typing

Teicoplanin and Meropenem Prophylaxis in Open Heart Surgery- Efficacy and Safety

Contact Info

Product

Resources

About