medigraphic.com

2014, Number 1

<< Back Next >>

Enf Infec Microbiol 2014; 34 (1)

Risk factors and mortality associated with mediastinitis in patients undergoing cardiac surgery

González FS, Molina GJ, Villela MLM

Language: Spanish
References: 25
Page: 13-25
PDF size: 215.81 Kb.


ABSTRACT

Background. Mediastinitis is a deep sternal infection, involving tissues or spaces below the subcutaneous tissue, with a high morbidity and mortality rates.
Material and Methods. A case-control transversal and retrospective study was conducted, from January 2010 to February 2012, in a regional hospital of the Social Security Mexican Institute (IMSS) to determine the risk factors for the occurrence of mediastinitis in patients with myocardial revascularization. For the statistical analysis SPSS 19th version was used. For the quantitative variables, central tendency and dispersion measurements were determined. For the difference we used T student. The qualitative variables were evaluated in proportions and differences were sought with X². Variables ≤ 0.1 will be included in a multivariate analysis by Cox hazard ratio with confidence intervals at 95%.
Results. Those variables associated with a diagnosis of mediastinitis vs. no mediastinitis were fever (› 38 °C) (RR 3.38, 95% CI: 2.24 to 4.91, 58% vs. 17%, p ‹ 0.0001), wound dehiscence (RR 40, 95% CI: 13-125, 70% vs. 2%, P ‹0.00001), wound drainage (RR 11.31, 95% CI: 6.45 to 19.84, 79% vs. 7%, p ‹ 0.0001). Enterobacteria were isolated in more of one third of the cases. Mortality rate was 53%, bleeding being the first cause of death.
Conclusions. Fever is the best predictor for mediastinitis.


REFERENCES

  1. Dial S, Nguyen D, Menzies D. “Autotransfusion of Shed Mediastinal Blood, A Risk Factor for Mediastinitis After Cardiac Surgery? Results of a Cluster Investigation”. CHEST 2003;124: 1847-1851.

  2. Exarhos DN, Malagari K, Tsatalou EG, Benakis SV, Peppas C, Kotanidou A, Chondros D, Roussos C. “Acute Mediastinitis: Spectrum of Computed Tomography Findings”. European Radiology 2005; 15: 1569-1574.

  3. Bilal MS, Gürer O, Kirbaş A, Yildiz Y, elebi A. “Cardiac Reoperation in a Patient Who Previously Underwent Omentoplasty for Postoperative mediastinitis: A Case Report.” Journal of Cardiothoracic Surgery 2011; 6:35.

  4. Robicsek F. “Postoperative Sterno – Mediastinitis”. Am Surg 2000; 66:184-192.

  5. Sexton DJ, Barlett JG, Baron EL. “Postoperative Mediastinitis After Cardiac Surgery”. Circulation 1995; 92: 2245-2251.

  6. Ariyaratnam P, Bland M, Loubani M. “Risk Factors and mortality Associated With Deep Sternal Wound Infections Following Coronary Bypass Surgery With or Without Concomitant Procedures in a UK Population: A Basis for a New Model?”. Interactive Cardiovascular and Thoracic Surgery 2010; 11: 543-546.

  7. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, Gorbach SL, Hischmann JV, Kaplan EL, Montoya JG, Wade JC. “Practice Guidelines for the Diagnosis and Management of Skin and Soft – Tissue Infections”. IDSA Guidelines 2005; 41: 1373-1406.

  8. Magedanz EH, Bodanese LC, Guaragna JCVC, Albuquerque LC, Martins V, Minossi SD, Piccoli JCE, Goldani MA. “Risk Score Elaboration for Mediastinitis After Coronary Artery Bypass Grafting”. Revista Brasileira de Cirugía Cardiovascular 2010; 25: 154-159.

  9. Sá MPBO, Silva DO, Lima ENS, Lima RC, Silva FPV, Rueda FG, Escobar RR, Cavalcanti EF. “Postoperative Mediastinitis in Cardiovascular Surgery. Analysis if 1038 Consecutive Surgeries”. Resvista Brasileira de Cirugía Cardiovascular 2010; 25:19-24.

  10. López Gude MJ, San Juan R, Aguado JM, Maroto L, López-Medrano F, Cortina Romero JM, Rufilanchas JJ. “Case-Control Study of Risk Factors for Mediastinitis After Cardiovascular Surgery”. Infection Control and Hospital Epidemiology 2006; 27: 1397-1400.

  11. Yamashiro T, Kamiya H, Murayama S, Unten S, Nakayama T, Gibo M, Kuniyoshi Y. “Infectious Mediastinitis After Cardiovascular Surgery: Role of Computed Tomography”. Radiat Med 2008;26: 343-347.

  12. Gao J, Wang Y, Lu S, Cai A, Yang Z, Han Z, Li J, Wen Y, Geng F, Wang W. “Management of Sternal Osteomyelitis and Mediastinal Infection Following Median Sternotomy”. Chinese Medical Journal 2010; 123:2803-2806.

  13. Muñoz P, Menasalvas A, Bernardo de Quirós JCL, Desco M, Vallejo JL, Bouza E. “Postsurgical Mediastinitis: A Case-Control Study”. Clinical Infectious Diseases 1997; 25:1060-1064.

  14. Betancourt Rodríguez JI, Lemus Lanziano JE, García del Río C, Urina Triana M. Manejo Postoperatorio de Cirugía Cardiovascular del Adulto. Cuidado Crítico Cardiovascular, Colombia, Ed Panamericana 2003: 193- 206. ISBN 97065-3-3.

  15. Molina JE. “Primary Closure for Infected Dehiscence of the Sternum”. Ann Thorac Surg 1993; 55:459 – 463.

  16. “Standards of Medical Care in Diabetes – 2012”. Diabetes Care 2012; 35: S11-S63.

  17. Kohut K, Meehan A, Chan M, Chinn R, Marx J, Ristaino P. “Guide for the Prevention of Mediastinitis Surgical Site Infection Following Cardiac Surgery”. APIC 2008: 1-45.

  18. Trick WE, Scheckler WE, Tokars JI, Jones KC, Smith EM, Reppen ML, Jarvis WJ. “Risk Factors for Radial Artery Harvest Site Infection Following Coronary Artery Bypass Graft Surgery”. Clinical Infectious Diseases 2000; 30: 270 – 275.

  19. Zerr KJ, Furnary AP, Grunkemeier GL, Bookin S, Kanhere V, Starr A. “Glucose Control Lowers the Risk of Wound Infection in Diabetics After Open Heart Operations”. Ann Thorac Surg 1997; 63: 356 – 361.

  20. Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS Jr. “The Association of Diabetes and Glucose Control With Surgical – Site Infections Among Cardiothoracic Surgery Patients”. Infect Contrl Hosp Epidemiol 2001; 22: 607 – 612.

  21. Zanetti G, Goldie S.J., Platt R. “Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery”. Emerging Infectious Diseases 2001; 7: 828 – 831.

  22. Zanetti G, Goldie SJ, Platt R. “Clinical Consequences and Cost of Limiting Use of Vancomycin for Perioperative Prophylaxis: Example of Coronary Artery Bypass Surgery”. Emerging Infectious Diseases 2001; 7: 820 – 827.

  23. Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WJ, McGowan JE, Sweet JrRL, Wenzel RP. “Quality Standard for Antimicrobial Prophylaxis in Surgical Procedures”. Clinical Infectious Diseases 1994; 18. 422 – 427.

  24. O´Grady NP, Barie PS, BartlettJG, Bleck T, Garvey G, Jacobi J, Linden P, Maki DG, Nam M, Pasculle W, Pasquale MD, Tribett DL, Masur H. “Practice Guidelines for Evaluating New Fever in Critically Ill Adult Patients”. Clinical Infectious Diseases 1998; 26:1042 – 1059.

  25. Mathias, JM. “Mediastinitis: Targeting Zero Infections”. OR Manager 2008; Jun 24 (6): 20-21.




2020     |     www.medigraphic.com