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2.
J Mycol Med ; 31(2): 101109, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33422936

RESUMO

We report a case of a 50-year-old shepherd hospitalized in intensive care unit for hiatal hernia complicated by an occlusive syndrome. In post-surgery, an acute respiratory distress occurs due to mediastinitis with large pleural effusion. At the laboratory, direct examination of the pleural sample revealed the presence of pseudohyphae. Kazachstania slooffiae was identified by Mass Spectrometry and confirmed by DNA sequencing. This uncommon yeast has never been previously described in human infections. Although its pathogenicity is not well known, K. slooffiae should be considered in the case of critically ill patients.


Assuntos
Micoses/diagnóstico por imagem , Derrame Pleural/microbiologia , Saccharomycetales/genética , Antifúngicos/uso terapêutico , Cuidados Críticos , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/cirurgia , Humanos , Masculino , Mediastinite/diagnóstico por imagem , Mediastinite/etiologia , Mediastinite/microbiologia , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/microbiologia , Saccharomycetales/efeitos dos fármacos , Saccharomycetales/isolamento & purificação , Saccharomycetales/patogenicidade , Análise de Sequência de DNA , Tomografia Computadorizada por Raios X
3.
Ann Thorac Cardiovasc Surg ; 27(1): 25-31, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32611929

RESUMO

PURPOSE: Deep sternal wound infection (DSWI) and mediastinitis are devastating complications after median sternotomy. Previous studies demonstrated an effective prevention of sternal wound infection (SWI) using an external sternal corset in high-risk cardiac surgery patients. The aim of this study is to assess the preventive effect of the Stern-E-Fix corset in high-risk poststernotomy female patients. METHODS: A total of 145 high-risk female patients undergoing cardiac surgery through median sternotomy were retrospectively analyzed. Patients were divided into group A (n = 71), who received the Stern-E-Fix corset (Fendel & Keuchen GmbH, Aachen, Germany), and group B (n = 74), who received the elastic thorax bandage (SanThorax) postoperatively for 6 weeks. The mean follow-up period was 12 weeks. RESULTS: Incidence of SWI was 7% in group A vs. 17.6% in group B (p = 0.025). One patient presented with DSWI in group A vs. seven patients in group B (p = 0.063). No patient developed mediastinitis in group A vs. four patients in group B (p = 0.121). In all, 4.2% of group A patients required operative wound therapy vs. 16.2% of group B patients (p = 0.026). The length of hospital stay was significantly longer in group B (p = 0.006). CONCLUSION: Using an external supportive sternal corset (Stern-E-Fix) yields a significantly better and effective prevention against development of sternal dehiscence, DSWI, and mediastinitis in high-risk poststernotomy female patients.


Assuntos
Braquetes , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Mediastinite/prevenção & controle , Esternotomia/efeitos adversos , Deiscência da Ferida Operatória/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de Fechamento de Ferimentos/instrumentação , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Tempo de Internação , Mediastinite/diagnóstico , Mediastinite/microbiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Fatores de Tempo , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos
4.
J Thorac Cardiovasc Surg ; 162(4): 1125-1130.e1, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32386766

RESUMO

OBJECTIVES: Perioperative bacterial decolonization and prophylactic antibiotic therapy at the Veterans Affairs Health Care System have changed over the past decade. Our objectives were to identify associated changes in the microbiology of mediastinitis and to perform a contemporary survival analysis in patients with mediastinitis after isolated coronary artery bypass grafting procedure. METHODS: From January 2006 to December 2015, 45,323 consecutive patients underwent coronary artery bypass grafting at 83 medical centers. The Veterans Affairs Health Care System nationwide administrative database was queried to identify patients with postoperative mediastinitis and obtain patient-level data. Simple descriptive statistics and multivariable logistic regression were used to analyze microbiologic data and identify risk factors for infection. Poisson regression was used to determine yearly incidence estimates. Cox proportional hazard model identified predictors of long-term survival from date of operation. RESULTS: During the study period, 348 patients (0.78%) developed postoperative mediastinitis-with a stable rate of incidence (Cochrane-Armitage test, P = .69). Of patients with microbiologic data, 75.5% of infections (n = 188) were caused by gram-positive and 24.5% (n = 61) gram-negative organisms. The incidence of methicillin-resistant Staphylococcus aureus mediastinitis decreased during the study period (Cochrane-Armitage test, P = .013). Gram-negative mediastinitis occurred earlier than gram-positive mediastinitis (median, 15.0 vs 25.0 days; P < .0001). Patients with mediastinitis did not have increased 30-day mortality (2.0% vs 1.9%; P = .9), but had worse long-term survival compared with uninfected patients (P < .0001). CONCLUSIONS: The incidence of methicillin-resistant S aureus mediastinitis has decreased over the past decade. Gram-negative bacteria are responsible for 1 in 4 cases of mediastinitis and infection is diagnosed earlier in the postoperative period than gram-positive mediastinitis. These findings highlight the need for efforts to prevent gram-negative and methicillin-susceptible S aureus mediastinitis.


Assuntos
Antibioticoprofilaxia/métodos , Ponte de Artéria Coronária/efeitos adversos , Mediastinite , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Complicações Pós-Operatórias , Infecções Estafilocócicas , Infecção da Ferida Cirúrgica , Idoso , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Incidência , Masculino , Mediastinite/epidemiologia , Mediastinite/etiologia , Mediastinite/microbiologia , Mediastinite/terapia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Modelos de Riscos Proporcionais , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Estados Unidos/epidemiologia , Saúde dos Veteranos/estatística & dados numéricos
5.
Ann Thorac Surg ; 111(6): e397-e398, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33290738

RESUMO

Descending necrotizing mediastinitis (DNM) is a severe form of mediastinitis with high mortality rates due to the rapid progression of infection into the mediastinum through tissue planes, often from a dental or pharyngeal source. We present a case of monomicrobial methicillin-resistant Staphylococcus aureus DNM in a healthy young man who was initially misdiagnosed with strep throat. This is well described in the pediatric literature; however, DNM in adults is typically polymicrobial and occurs in those with comorbidities such as diabetes mellitus and older age. Survival is excellent with early identification of mediastinitis, prompt surgical intervention, and appropriate antibiotics.


Assuntos
Mediastinite/microbiologia , Mediastinite/patologia , Mediastino/patologia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/patologia , Humanos , Masculino , Necrose/microbiologia , Índice de Gravidade de Doença , Adulto Jovem
6.
Ann Thorac Surg ; 111(6): e403-e406, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33232726

RESUMO

Descending necrotizing mediastinitis is a life-threatening disease that extends into the pretracheal, perivascular, retrovisceral, and/or prevertebral spaces, generally sparing the esophagus. We report a case of deep neck abscess complicated by phlegmonous esophagitis and mediastinitis. The patient was successfully treated with antibiotics and surgery, combining transcervical and bilateral thoracoscopic transthoracic mediastinal drainage. However, a pseudo-lumen with a large amount of pus remained in the esophagus. The septum between the true and the pseudo-lumen was cut endoscopically, after which the patient recovered well without any complications.


Assuntos
Abscesso/complicações , Celulite (Flegmão)/microbiologia , Esofagite/microbiologia , Firmicutes , Infecções por Bactérias Gram-Positivas/complicações , Mediastinite/microbiologia , Abscesso/terapia , Celulite (Flegmão)/terapia , Esofagite/terapia , Feminino , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Mediastinite/terapia , Pessoa de Meia-Idade , Pescoço
7.
J Card Surg ; 35(11): 3191-3194, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32740995

RESUMO

Mycobacterium chimaera can cause disseminated infection following cardiac surgery with cardiopulmonary bypass and contaminated heater-cooler devices. We discuss a 41-year-old man with a disseminated M. chimaera infection following surgery for a type A aortic dissection. His presentation included cachexia and dorsalgia with a work-up revealing vertebral osteomyelitis with an epidural abscess, bone marrow, and pulmonary infiltration, and fluid collection around his aortic graft. He received 1 month of antibiotics before the explantation of infected foreign material, mediastinal debridement, and aortic reconstruction. Complications included septic shock, respiratory and renal failure, mediastinitis, and four distal aortic anastomotic dehiscences from friable tissue and persistent infection.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Mediastinite/etiologia , Mediastinite/cirurgia , Infecções por Mycobacterium/etiologia , Infecções por Mycobacterium/cirurgia , Mycobacterium , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Adulto , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar/efeitos adversos , Evolução Fatal , Humanos , Masculino , Mediastinite/microbiologia , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/microbiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Reoperação , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/microbiologia
8.
J Int Med Res ; 48(5): 300060520918469, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32431185

RESUMO

Acute mediastinitis (AM) is a rare but life-threatening disease. Here, we report a case of AM secondary to endobronchial tuberculosis (EBTB) and pseudomembranous Aspergillus tracheobronchitis (PMATB) co-infection. EBTB was confirmed by tissue culture for Mycobacterium tuberculosis and GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) detection (simultaneous detection of M. tuberculosis and resistance to rifampin) using endobronchial biopsies; PMATB was confirmed by histopathology. Even with antibiotic treatment and systemic support treatment, the patient died of massive hemoptysis on day 10 after admission. When immunocompromised hosts have AM, especially with central airway involvement, EBTB and aspergillosis should be considered potential causes. Bronchoscopy is helpful for rapid diagnosis and administering precise treatment.


Assuntos
Aspergilose/complicações , Coinfecção/complicações , Complicações do Diabetes/complicações , Mediastinite/microbiologia , Tuberculose Pulmonar/complicações , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Antituberculosos/uso terapêutico , Aspergilose/diagnóstico , Aspergilose/imunologia , Aspergilose/microbiologia , Aspergillus/imunologia , Aspergillus/isolamento & purificação , Brônquios/diagnóstico por imagem , Brônquios/microbiologia , Brônquios/patologia , Broncoscopia , Coinfecção/diagnóstico , Coinfecção/imunologia , Coinfecção/microbiologia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/imunologia , Complicações do Diabetes/microbiologia , Evolução Fatal , Feminino , Humanos , Hifas/isolamento & purificação , Hospedeiro Imunocomprometido , Mediastinite/diagnóstico , Mediastinite/tratamento farmacológico , Mediastinite/etiologia , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/microbiologia
9.
BMC Infect Dis ; 20(1): 354, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429852

RESUMO

BACKGROUND: Mediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA). CASE PRESENTATION: A 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics. CONCLUSIONS: We present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.


Assuntos
Toxinas Bacterianas/análise , Infecções Comunitárias Adquiridas/diagnóstico , Exotoxinas/análise , Imunocompetência , Leucocidinas/análise , Mediastinite/diagnóstico , Mediastinite/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/metabolismo , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Clindamicina/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Drenagem , Humanos , Masculino , Mediastinite/tratamento farmacológico , Mediastinite/imunologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
10.
Artigo em Chinês | MEDLINE | ID: mdl-32306633

RESUMO

Objective: To explore the clinical experience in care for deep neck infection (DNI) and to analyze the factors influencing surgical treatment outcome. Methods: A retrospective analysis was conducted on 61 patients with DNI admitted to the Department of Otorhinolaryngology Head and Neck Surgery of Yantai Yuhuangding Hospital from March 2013 to April 2019, including 33 males and 28 females, aged from 6 months to 81 years with a median age of 49 years. Patients were divided into two groups, 31 cases with localized infection (neck abscess) in Group A and 30 cases with diffuse infection (neck necrotizing fasciitis) in Group B. Patients in two groups were compared for sex, age, hospital stay, diabetes, tracheostomy, drainage methods, mediastinal infection, and pathogenic bacteria. The influence of different drainage methods on hospital stay in Group A was analyzed. SPSS 25.0 software was used for statistical analysis. Results: Of the 61 patients, 45 patients underwent surgical incision and drainage (21 cases in Group A and 24 cases in Group B), 23 patients underwent ultrasound-guided fine needle aspiration (UG-FNA) and catheter drainage (10 cases in Group A and 13 cases in Group B), and 7 patients in Group B were treated with both drainage methods. Pathogens were cultured in 31 cases (50.82%). There were significant differences in hospital stay, drainage method and mediastinal infection (χ(2) values were 26.890, 8.687 and 6.035, respectively, P<0.05), but no significant difference was found in sex, age, diabetes, tracheotomy and pathogenic bacteria (χ(2) values were 0.157, 3.685, 2.434, 3.631 and 0.807, respectively, P>0.05) between the two groups. There was no significant difference in hospital stay between two drainage methods in patients in Group A (χ(2)=1.560, P>0.05). Conclusions: There were significant differences in hospital stay, drainage method and mediastinal infection between patients with localized infection and diffuse infection, as diffuse infection is often associated with serious complications. UG-FNA and catheter drainage is an optional method for the treatment of localized infection, with minimal invasion and no influence on hospital stay.


Assuntos
Abscesso/microbiologia , Infecções Bacterianas/patologia , Fasciite Necrosante/microbiologia , Mediastinite/microbiologia , Pescoço/microbiologia , Pescoço/patologia , Abscesso/patologia , Abscesso/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/terapia , Criança , Pré-Escolar , Drenagem , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Mediastinite/patologia , Mediastinite/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
BMC Pulm Med ; 20(1): 43, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066414

RESUMO

Descending necrotizing mediastinitis is a severe infection of the mediastinum. This syndrome manifests as fever and chest pain following cough and sputum production. A 49-year-old woman presented with fever and a 14-day history of pneumonia. CT showed mediastinal abscesses with a giant calcified mediastinal lymph node (21 × 18 mm) and pneumonia. Bronchoscopy by EBUS-TBNA under general anesthesia was performed. The pathogen found in the puncture culture was Streptococcus constellatus, and antibiotics (mezlocillin/sulbactam 3.375 IVGTT q8h) was administered. A proximal right main bronchial neoplasm, suspected lung cancer, was found and conformed to inflammatory granuloma. A total of 22 months post-discharge the patient was clinically stable. We also conducted a review of the literature for all Streptococcus constellatus descending necrotizing mediastinitis infections between 2011 and 2017.


Assuntos
Broncoscopia , Mediastinite/microbiologia , Pneumonia/complicações , Infecções Estreptocócicas/microbiologia , Streptococcus constellatus/isolamento & purificação , Antibacterianos/uso terapêutico , Drenagem/métodos , Feminino , Humanos , Imunocompetência , Linfonodos/patologia , Mediastinite/diagnóstico , Mediastinite/terapia , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Tomografia Computadorizada por Raios X
13.
Cardiol Young ; 30(1): 134-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31916528

RESUMO

This report describes a 3-year-old infant with post-operative mediastinitis complicated by a contained rupture of the right ventricle. A contained rupture is recognised as the huge pulsating prominence of the anterior chest wall. CT confirmed blood communication between the right ventricular outflow tract and the cavity surrounded by the pectoral major musculocutaneous flap. This is a significant case in which severe adhesion between the right ventricle and the musculocutaneous flap could maintain her stable haemodynamics with a pulsating prominence.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Dupla Via de Saída do Ventrículo Direito/cirurgia , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Pré-Escolar , Feminino , Ventrículos do Coração/lesões , Ventrículos do Coração/cirurgia , Humanos , Mediastinite/microbiologia , Retalho Miocutâneo/transplante , Complicações Pós-Operatórias/cirurgia , Reoperação , Tomografia Computadorizada por Raios X
14.
Interact Cardiovasc Thorac Surg ; 30(4): 523-527, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31958124

RESUMO

OBJECTIVES: Nosocomial infection caused by Serratia marcescens after cardiac surgery is rare but causes high rates of morbidity and mortality. Knowledge about postoperative mediastinitis due to S. marcescens is limited. The purpose of this work was to study the clinical presentation, management and outcome of an outbreak of postoperative sternal infection due to S. marcescens. METHODS: During a 7-week period, a total of 54 patients underwent open heart procedures in our hospital. A postoperative wound infection caused by S. marcescens was diagnosed in 10 patients. We performed a clinical study to investigate patient characteristics and outcomes as well as the possible source of the infection. RESULTS: The mean age of the infected patients was 74.5 ± 10 years. Mediastinitis was present in 6 cases, superficial wound infection in 3 and isolated bacteraemia in 1. Purulent exudate through the sternal incision was observed in all infected cases except in 1 patient, who presented only with bacteraemia. Serratia marcescens was isolated from the samples taken from all infected wounds. The mean time elapsed between the operation and the isolation S. marcescens was 5.9 ± 2.4 days. Response to treatment was favourable in all cases except 1, who died. Contamination of the aqueous chlorhexidine solution used to prepare the patients' skin with S. marcescens was reported. Microbiological studies demonstrated that S. marcescens strains isolated from patients and from the aqueous chlorhexidine solution belonged to the same clone. CONCLUSIONS: The use of an aqueous chlorhexidine solution contaminated with S. marcescens caused an outbreak of postoperative sternal wound infections. The time elapsed between wound contamination and signs of infection was brief, but the systemic inflammatory response and tissue necrosis were limited. Alcohol-based solutions are recommended for the prevention of surgical site infections.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Clorexidina , Contaminação de Medicamentos , Infecções por Serratia/epidemiologia , Serratia marcescens/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Surtos de Doenças , Feminino , Humanos , Masculino , Mediastinite/diagnóstico , Mediastinite/microbiologia , Pessoa de Meia-Idade , Infecções por Serratia/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia
15.
Laryngoscope ; 130(11): E567-E572, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31747058

RESUMO

OBJECTIVES/HYPOTHESIS: To identify the clinical predictors of descending necrotizing mediastinitis (DNM) secondary to deep neck infections (DNIs) before treatment. STUDY DESIGN: Retrospective case series. METHODS: We reviewed 73 patients with DNIs who had been treated with external drainage at our institute between April 2009 and March 2019. We divided these patients into either a DNI group without mediastinitis (n = 55) or a DNM group secondary to DNI (n = 18). We collected clinical data and compared them between the groups, conducting univariate and multiple logistic regression analysis to identify the predictors of DNM. RESULTS: We identified age, C-reactive protein (CRP), neutrophil percentage, lymphocyte percentage, neutrophil to lymphocyte ratio (NLR), presence of comorbidities, presence of gas, and abscess extension below the hyoid bone as statistically significant by univariate analysis. Moreover, multiple logistic regression analysis showed that age ≥55 years, NLR ≥13, and CRP ≥30 mg/dL were statistically significant. CONCLUSIONS: We identified age ≥55, NLR ≥13, and CRP ≥30 before DNI treatment as clinical predictors of a DNM complication. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E567-E572, 2020.


Assuntos
Doenças da Laringe/complicações , Mediastinite/etiologia , Mediastino/patologia , Doenças Faríngeas/complicações , Infecções Respiratórias/complicações , Abscesso/sangue , Abscesso/complicações , Abscesso/microbiologia , Fatores Etários , Proteína C-Reativa , Drenagem , Feminino , Humanos , Osso Hioide/microbiologia , Osso Hioide/patologia , Doenças da Laringe/sangue , Doenças da Laringe/microbiologia , Contagem de Leucócitos , Modelos Logísticos , Linfócitos , Masculino , Mediastinite/microbiologia , Mediastinite/patologia , Mediastino/microbiologia , Pessoa de Meia-Idade , Pescoço/microbiologia , Pescoço/patologia , Necrose , Neutrófilos , Doenças Faríngeas/sangue , Doenças Faríngeas/microbiologia , Infecções Respiratórias/sangue , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Fatores de Risco
16.
Int J Infect Dis ; 90: 201-205, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31525520

RESUMO

OBJECTIVES: The aim of this study was to elaborate on and validate a score for the early diagnosis of mediastinitis after cardiothoracic surgery. METHODS: Between 2007 and 2017, patients who experienced thoracic surgical-site infection after cardiothoracic surgery were enrolled. Laboratory, clinical, and chest CT findings were retrospectively analyzed. Patients were followed up until hospital discharge or intra-hospital death. Univariate and multivariate regression analyses were performed. RESULTS: 950 surgical-site infections were found and analyzed (131 mediastinitis, 819 superficial/deep infections). Of the 131 mediastinitis episodes, 88% required surgical thoracic debridement,Staphylococcus aureus was identified in 43%, and overall mortality was 42%. The following variables were related to mediastinitis diagnosis: sternal diastasis (OR=2.5; 95% confidence interval [95%CI]: 1.2-5.3; P=0.012), bilateral pleural effusion (OR=1.9; 95%CI: 1.0-3.6; P=0.04), leukocyte count ≥14,000cells/mm3 (OR=2.5; 95%CI: 1.3-4.7; P=0.006), male sex (OR=2; 95%CI: 1.11-4; P=0.022), and positive blood culture (OR=3.0; 95%CI: 1.6-5.6; P=0.001). The score predicted with reasonable accuracy mediastinitis in the derivation cohort (AUC-ROC, 0.7476) and the validation cohort (AUC-ROC, 0.7149). Groups with high (31%) and low (5%) risk of mediastinitis were identified. CONCLUSIONS: An early diagnostic score in patients with surgical-site infection after cardiothoracic surgery identified groups with a low and high risk for mediastinitis.


Assuntos
Mediastinite/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Mediastinite/etiologia , Mediastinite/microbiologia , Mediastinite/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Esterno , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/mortalidade , Adulto Jovem
17.
Clin Microbiol Infect ; 26(1): 26-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31306791

RESUMO

BACKGROUND: Mediastinitis is a rare but severe infection, defined as an inflammation of the connective tissues and structures within the mediastinum. Due to its proximity to vital structures, mediastinitis represents a highly morbid pathological process associated with a high risk of mortality. In most cases mediastinitis requires treatment in the intensive care unit. OBJECTIVES: To highlight to the reader the clinical features of mediastinitis, to attempt to define each clinical scenario, to describe the responsible pathogens and finally to depict both the medical and surgical treatments. SOURCES: We performed a literature search of the PubMed and Cochrane libraries, limited for articles published between January 2003 and December 2018, reporting on acute mediastinitis. CONTENT: The term covers different entities of different aetiologies including deep sternal wound infection related to sternotomy; oesophageal perforation or anastomosis leakage; and finally descending necrotizing mediastinitis, often secondary to oropharyngeal abscess. The responsible pathogens and therefore subsequent management depends on the underlying aetiology. Empirical antimicrobial therapy should cover the suspected microorganisms while surgery and supportive measures should aim to reduce the inoculum of pathogens by providing adequate drainage and debridement. IMPLICATIONS: Literature concerning mediastinitis in the intensive care unit is relatively scarce. We have collated the evidence and reviewed the different causes and treatment options of acute mediastinitis with a particular focus on microbiological epidemiology. Future research in larger cohorts is needed to better understand the treatment of this difficult disease.


Assuntos
Unidades de Terapia Intensiva , Mediastinite/microbiologia , Abscesso , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Bacterianas/terapia , Desbridamento , Drenagem , Humanos , Mediastinite/mortalidade , Mediastinite/terapia , Orofaringe/microbiologia , Sepse
18.
Surg Infect (Larchmt) ; 21(4): 370-377, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31809233

RESUMO

Background: Mediastinitis after cardiac surgery can lead to devastating consequences such as deep sternal wound infections (DSWI). Staphylococcus epidermidis and other coagulase-negative staphylococci belong to the physiological skin flora and therefore generally are not considered pathogenic agents. Thus, local resistance patterns of these bacterial species often recovered from wound specimens generally are ignored while choosing antibiotics for peri-operative prophylaxis in cardiac surgery as well as in the selection of empiric antibiotic therapy of DSWI. Methods: During the period May 2012-May 2013, 52 patients suffering from DSWI were treated at our institution. For every patient, deep tissue samples were obtained during surgical debridement procedures and submitted to microbiologic analysis. The frequency of and the time to occurrence of a DSWI was recorded, and baseline data, previous operative interventions, complications, and the technique used for soft tissue reconstruction, as well as the microbiologic results and individual risk factors, were documented. Results: There were 32 male patients (62%) and 20 female. The patients' age at the time of revision was a mean of 67 ± 11.5 years (range 35-83 years). There was bacterial growth in 31 cases (60%), the predominant species being S. epidermidis (20 patients; 65%). Extended antibiotic therapy was indispensable to controlling the infection. Conclusion: The local resistance patterns of antibiotics should have a greater influence on the standardized prophylaxis or empirical therapy of DSWI and need to be discussed specifically for this high-risk population. Because of its multi-resistance spectrum, S. epidermidis must be classified as a potential pathogen. In the cases reported here, extended antibiotic therapy was necessary to support wound healing and thus good patient outcomes.


Assuntos
Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Esterno/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Desbridamento/efeitos adversos , Desbridamento/métodos , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Mediastinite/complicações , Mediastinite/microbiologia , Pessoa de Meia-Idade , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia , Cicatrização
20.
Thorac Cardiovasc Surg ; 68(8): 752-754, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31539921

RESUMO

Sternal instability after cardiac surgery can lead to poor bony healing, as well as deep sternal wound infections and mediastinitis. Rigid plate fixation is associated with greater stability and fewer complications compared with wire cerclage, however, rigid plate fixation alone lacks posterior stability of the sternum and may be less effective in morbidly obese or osteoporotic patients. This article describes a surgical technique of combined rigid plate fixation and wire cerclage that provides 360-degree stabilization for sternotomies in high-risk patients. We employed this technique in 40 patients with no incidence of deep sternal wound infection.


Assuntos
Placas Ósseas , Fios Ortopédicos , Procedimentos Cirúrgicos Cardíacos , Fixação Interna de Fraturas/instrumentação , Esternotomia , Esterno/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Mediastinite/microbiologia , Mediastinite/prevenção & controle , Desenho de Prótese , Medição de Risco , Fatores de Risco , Esternotomia/efeitos adversos , Esterno/diagnóstico por imagem , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
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