GARDLUND B, BITCOVER C, VAAGE J; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2000 Sep 17-20; 40: 406.
Dept of Infectious Diseases, Karolinska Hosp, Stockholm, Sweden
BACKGROUND: Postoperative mediastinitis developed after 110 (1.46 %) of 7525 consecutive cardiac surgery procedures during a 7 year period, 1992-1998.METHODS: The records of these 110 cases of mediastinitis were reviewed.RESULTS: Coagulase negative staphylococci (CNS) were isolated in 48%, Staphylococcus aureus in 22 %, and gram-negatives in 18 % of the cases with a verified microbiological etiology. CNS etiology was associated with sternal dehiscence on reoperation (p=0.003) whereas S aureus was more often found in patients with stable sternum (p<0.001). Gram-negative mediastinitis occurred equally often in both stable and unstable sternum. Obesity was associated with CNS etiology (p<0.001) and with sternal dehiscence (p=0.008). Chronic obstructive pulmonary disease (COPD) was also associated with sternal dehiscence (p=0.01) and CNS (p=0.03). CNS etiology was more often associated with little or no clinical signs of mediastinitis before reoperation than other bacterial etiologies (p=0.001), and was rarely found in blood cultures in contrast to Staphylococcus aureus and gram negative bacteria. Conclusion: We identify three basically different types of postoperative mediastinitis: 1) Mediastinitis mainly caused by CNS, often associated with obesity and sternal dehiscence and sometimes also with COPD, 2) Staphylococcus aureus mediastinitis following peroperative contamination of the mediastinal space and 3) gram-negative mediastinitis possibly caused by hematogenous spread from concomitant infections in other sites than the mediastinum in the postoperative period. This new classification can be useful in launching appropriate infection control programs.KEYWORDS: Cardiac surgery; Mediastinitis; Surgical infections
Publication Types:
Keywords:
- Cardiac Surgical Procedures
- Gram-Negative Bacteria
- Humans
- Mediastinitis
- Reoperation
- Staphylococcus
- Staphylococcus aureus
- Sternum
- etiology
- microbiology
- surgery
Other ID:
UI: 102248911
From Meeting Abstracts