| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2002;21:825-830
© 2002 Elsevier Science NL
a Department of Infectious Diseases, Karolinska Hospital, Stockholm, Sweden
b Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden
Received 24 August 2001; received in revised form 27 January 2002; accepted 31 January 2002.
* Corresponding author. Tel.: +46-8-5177-0000; fax: +46-8-5177-1885
e-mail: bengt.gardlund{at}ks.se
Objective: During 1992–2000, postoperative mediastinitis developed after 126 (1.32%) of 9557 consecutive cardiac surgery procedures. The study was done to describe the variation in clinical characteristics and microbiological etiology in mediastinitis. Methods: The records of 126 cases of postoperative mediastinitis were reviewed. Results: The median time from operation to the development of mediastinitis was 7 days. Sternal dehiscence was seen in 86 patients (68%). Coagulase negative staphylococci (CNS) were isolated in 46% of the cases with a verified microbiological etiology, Staphylococcus aureus in 26% and gram-negative bacteria in 18%. CNS were more frequently isolated in patients with sternal dehiscence (44/80, 55%) than in patients with stable sternum (10/38, 26%) (P=0.003). However, S. aureus was more frequent in patients with stable sternum (18/38, 47%) than in patients with sternal dehiscence (13/80, 16%) (P<0.001). High body mass index was associated with coagulase negative staphylococci (P<0.001) and with sternal dehiscence (P=0.008). Chronic obstructive pulmonary disease was also associated with sternal dehiscence (P<0.001) and with coagulase negative staphylococci (P=0.04). Patients who had been reoperated before onset of mediastinitis tended to have an increased risk for a gram-negative etiology (32 vs. 15% in patients not reoperated, P=0.06). The overall 90-day all cause mortality in patients with mediastinitis was 19%. High age, need for reoperation before mediastinitis, and a long primary operation time was associated with increased mortality (P=0.02, P=0.007 and P=0.001, respectively). No specific bacterial etiology was associated with increased mortality nor was the presence of bacteriemia. Conclusions: Three different types of postoperative mediastinitis can be distinguished: (1) mediastinitis associated with obesity, chronic obstructive pulmonary disease, and sternal dehiscence, typically caused by coagulase negative staphylococci; (2) mediastinitis following peroperative contamination of the mediastinal space, often caused by S. aureus, and (3) mediastinitis mainly caused by spread from concomitant infections in other sites during the postoperative period, often caused by gram negative rods. The proposed classification of mediastinitis into three groups with different pathogenic mechanisms may be useful in understanding which prophylactic counter measures have the potentials to be effective in a given situation.
Key Words: Cardiac surgery • Mediastinitis • Postoperative complications • Surgical wound infection • Staphylococcus
This article has been cited by other articles:
|
|
 |
|
  A. J. Poncelet, B. Lengele, B. Delaere, F. Zech, D. Glineur, J.-C. Funken, G. El Khoury, and P. Noirhomme Algorithm for primary closure in sternal wound infection: a single institution 10-year experience Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 232 - 238. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. San Juan, F. Chaves, M. J. Lopez Gude, C. Diaz-Pedroche, J. Otero, J. M. Cortina Romero, J. J. Rufilanchas, and J. M. Aguado Staphylococcus aureus poststernotomy mediastinitis: Description of two distinct acquisition pathways with different potential preventive approaches J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 670 - 676. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Dhadwal, S. Al-Ruzzeh, T. Athanasiou, M. Choudhury, P. Tekkis, P. Vuddamalay, H. Lyster, M. Amrani, and S. George Comparison of clinical and economic outcomes of two antibiotic prophylaxis regimens for sternal wound infection in high-risk patients following coronary artery bypass grafting surgery: a prospective randomised double-blind controlled trial Heart, September 1, 2007; 93(9): 1126 - 1133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Fleck, R. Moidl, A. Blacky, M. Fleck, E. Wolner, M. Grabenwoger, and W. Wisser Triclosan-Coated Sutures for the Reduction of Sternal Wound Infections: Economic Considerations Ann. Thorac. Surg., July 1, 2007; 84(1): 232 - 236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Mand'ak, M. Pojar, J. Malakova, V. Lonsky, V. Palicka, and P. Zivny Tissue and plasma concentrations of cephuroxime during cardiac surgery in cardiopulmonary bypass--a microdialysis study. Perfusion, March 1, 2007; 22(2): 129 - 136. [Abstract] [PDF]
|
|
|
|
|
|
J. Sjogren, M. Malmsjo, R. Gustafsson, and R. Ingemansson Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum-assisted closure therapy and presentation of the Lund University Hospital mediastinitis algorithm Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 898 - 905. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Eklund, O. Lyytikainen, P. Klemets, K. Huotari, V.-J. Anttila, K. A. Werkkala, and M. Valtonen Mediastinitis After More Than 10,000 Cardiac Surgical Procedures Ann. Thorac. Surg., November 1, 2006; 82(5): 1784 - 1789. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Karra, L. McDermott, S. Connelly, P. Smith, D. J. Sexton, and K. S. Kaye Risk factors for 1-year mortality after postoperative mediastinitis. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 537 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Mills and P. Bryson The role of hyperbaric oxygen therapy in the treatment of sternal wound infection. Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 153 - 159. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Fleck, R. Moidl, P. Giovanoli, O. Aszmann, A. Bartunek, A. Blacky, M. Grabenwoger, and E. Wolner A conclusion from the first 125 patients treated with the vacuum assisted closure system for postoperative sternal wound infection Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 145 - 148. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. F. Immer, M. Durrer, K. S. Muhlemann, D. Erni, B. Gahl, and T. P. Carrel Deep Sternal Wound Infection After Cardiac Surgery: Modality of Treatment and Outcome Ann. Thorac. Surg., September 1, 2005; 80(3): 957 - 961. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sjogren, R. Gustafsson, J. Nilsson, M. Malmsjo, and R. Ingemansson Clinical Outcome After Poststernotomy Mediastinitis: Vacuum-Assisted Closure Versus Conventional Treatment Ann. Thorac. Surg., June 1, 2005; 79(6): 2049 - 2055. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. K. Toumpoulis, C. E. Anagnostopoulos, J. J. DeRose Jr, and D. G. Swistel The Impact of Deep Sternal Wound Infection on Long-term Survival After Coronary Artery Bypass Grafting Chest, February 1, 2005; 127(2): 464 - 471. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Friberg, R. Svedjeholm, B. Soderquist, H. Granfeldt, T. Vikerfors, and J. Kallman Local Gentamicin Reduces Sternal Wound Infections After Cardiac Surgery: A Randomized Controlled Trial Ann. Thorac. Surg., January 1, 2005; 79(1): 153 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sjogren, R. Gustafsson, A. Wackenfors, M. Malmsjo, L. Algotsson, and R. Ingemansson Effects of vacuum-assisted closure on central hemodynamics in a sternotomy wound model Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 666 - 671. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. C. Douville, J. W. Asaph, R. J. Dworkin, J. R. Handy Jr, C. S. Canepa, G. L. Grunkemeier, and Y. Wu Sternal Preservation: A Better Way to Treat Most Sternal Wound Complications After Cardiac Surgery Ann. Thorac. Surg., November 1, 2004; 78(5): 1659 - 1664. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. I. Gustafsson, J. Sjogren, and R. Ingemansson Deep sternal wound infection: a sternal-sparing technique with vacuum-assisted closure therapy Ann. Thorac. Surg., December 1, 2003; 76(6): 2048 - 2053. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Tortoriello, J. D. Friedman, E. D. McKenzie, C. D. Fraser, T. F. Feltes, J. Randall, and A. R. Mott Mediastinitis after pediatric cardiac surgery: a 15-year experience at a single institution Ann. Thorac. Surg., November 1, 2003; 76(5): 1655 - 1660. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
