Effect of time to onset on clinical features and prognosis of post-sternotomy mediastinitis.

Details

Serval ID
serval:BIB_4533938B7702
Type
Article: article from journal or magazin.
Collection
Publications
Title
Effect of time to onset on clinical features and prognosis of post-sternotomy mediastinitis.
Journal
Clinical microbiology and infection
Author(s)
Mekontso Dessap A., Vivier E., Girou E., Brun-Buisson C., Kirsch M.
ISSN
1469-0691 (Electronic)
ISSN-L
1198-743X
Publication state
Published
Issued date
02/2011
Peer-reviewed
Oui
Volume
17
Number
2
Pages
292-299
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Incubation time affects the clinical features and outcome of many nosocomial infections. However, its role in the setting of post-sternotomy mediastinitis (PSM) has not been specifically studied. The present study aimed to evaluate the impact of time to onset of PSM on the clinical presentation and outcomes of patients. Hospital records of 197 patients who developed PSM over a 10-year period and were treated by closed drainage using Redon catheters were reviewed retrospectively. Follow-up was complete for all included patients (median of 19 months); 98 patients developed early-onset PSM (time from initial operation to PSM <14 days) and 99 patients had late-onset PSM (≥14 days). Patients with late-onset PSM had a higher rate of internal thoracic artery harvest and mediastinal re-exploration after initial operation. Patients with early-onset PSM presented more frequently with septic shock. Microbiological findings differed between early- and late-onset PSM by a higher incidence of Enterococcus species in the former and of Staphylococcus aureus in the latter. Overall mortality reached 34% (n = 66). Rates of superinfection, treatment failure, mediastinitis-related death, mortality at 1 year and overall mortality were all significantly higher in patients with early-onset PSM. Multiple regression procedures identified early-onset PSM as a significant and independent risk factor for both 1-year (OR 2.40; 95% CI 1.12-5.11) and overall (OR 2.11; 95% 1.26-3.53) mortality. In conclusion, the results obtained in the present study support the distinction between early- and late-onset PSM with different clinical and pathophysiological features. Early-onset PSM is associated with a significantly higher morbidity and mortality compared to late-onset PSM.
Keywords
Aged, Aged, 80 and over, Bacteria/isolation & purification, Bacterial Infections/microbiology, Bacterial Infections/pathology, Female, Humans, Infectious Disease Incubation Period, Male, Mediastinitis/microbiology, Mediastinitis/pathology, Middle Aged, Prognosis, Retrospective Studies, Sternotomy/adverse effects, Surgical Wound Infection/microbiology, Surgical Wound Infection/pathology
Pubmed
Web of science
Open Access
Yes
Create date
29/03/2019 7:06
Last modification date
20/08/2019 13:49
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