LESCURE FX, DOUADI Y, TROJETTE F, TOUATI G, REMADI JP, POULAIN H, SCHMIT JL; 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 Internal Med. and Infectious Dis., Amiens, Place Victor Pauchet, France

BACKGROUND: The current treatment of post sternotomy mediastinitis is surgical. Med. treatment is not usually recommended but in fact, all cases of deep wound infection after sternotomy are not systematically reoperated in our institution. Objective: To compare clinical characteristics and outcome of post sternotomy cases of mediastinitis treated with or without surgical drainage.METHODS: Retrospectively, we reviewed all cases of post sternotomy mediastinitis (CDC criteria) observed from 1993 to 1999 in our cardiac surgery unit. Three surgeons (A,B,C) officiate in the unit: ``A delays the surgical drainage up to 2 or 3 days after the onset, if the patient doesnt improve with broad spectrum antibiotherapy. ``B and ``C are more in favour of primary surgical drainage.RESULTS: 18 cases were recorded; 8 treated only with antibiotherapy (group 1) and 10 treated with surgery and antibiotherapy (group 2). The 2 groups were comparable in terms of demographic, clinical and radiological parameters; there were more patients in good general state (ASA=1) in the group 1 (4/8 versus 2/10 in the group 2). Bacteriemia isolated were 5 Gram Positive Cocci (3 CNS, 2 S.aureus), 6 Gram Negative Bacilli (2 Pseudomonas sp, 4 Enterobacteriaceae): all mediastinitis with S. aureus were surgicaly treated. The two cases with Pseudomonas sp were medically treated with success. In the group 1, the symptoms occurred earlier (7 days) that in group 2 (10 days) p=0.01. Two patients of group 2 died post operatively. All the others patients were cured. 6 out of 8 patients of group 1 where handled by surgeon ``A. Conclusion: This study suggests that antibiotherapy alone may be a safe treatment for the post sternotomy mediastinitis occurring before 7 days, at least when S. aureus is not involved.KEYWORDS: Antibiotherapy; Mediastinitis; Nosocomial

Publication Types:

• Meeting Abstracts

Keywords:

• Bacteremia
• Cardiac Surgical Procedures
• Cardiopulmonary Bypass
• Coronary Artery Bypass
• Debridement
• Drainage
• Gram-Negative Bacteria
• Humans
• Mediastinitis
• Prosthesis Implantation
• Reoperation
• Suture Techniques
• Thoracotomy
• Tracheostomy
• surgery
• therapy

Other ID:

• GWAIDS0011414

UI: 102248912

From Meeting Abstracts