Usefulness of routine epicardial pacing wire culture for early prediction of poststernotomy mediastinitis.

Détails

ID Serval
serval:BIB_7AEA10BC6F6F
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Usefulness of routine epicardial pacing wire culture for early prediction of poststernotomy mediastinitis.
Périodique
Journal of clinical microbiology
Auteur(s)
Mekontso-Dessap A., Honoré S., Kirsch M., Houël R., Loisance D., Brun-Buisson C.
ISSN
0095-1137 (Print)
ISSN-L
0095-1137
Statut éditorial
Publié
Date de publication
11/2004
Peer-reviewed
Oui
Volume
42
Numéro
11
Pages
5245-5248
Langue
anglais
Notes
Publication types: Evaluation Studies ; Journal Article
Publication Status: ppublish
Résumé
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.
Mots-clé
Adolescent, Adult, Aged, Aged, 80 and over, Bacteria/classification, Bacteria/isolation & purification, Bacteriological Techniques, Cardiac Surgical Procedures, Culture Media, Electrodes, Implanted/microbiology, Female, Humans, Male, Mediastinitis/diagnosis, Mediastinitis/microbiology, Middle Aged, Pacemaker, Artificial, Postoperative Complications/diagnosis, Postoperative Complications/microbiology, Staphylococcus aureus/isolation & purification, Sternum/surgery
Pubmed
Web of science
Open Access
Oui
Création de la notice
30/03/2019 17:53
Dernière modification de la notice
20/08/2019 15:36
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