Sequential antimicrobial therapy in mediastinitis after cardiac surgery: An observational study of 81 cases |
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| Affiliation: | 1. Cardiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain;2. Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain;3. Cardiovascular Surgery Unit, Hospital Universitario Virgen Macarena, Seville, Spain;1. Servicio de Microbiología, Hospital Universitario Vall d’Hebron, Universitat Autònoma de Barcelona, PROSICS, Barcelona, España;2. Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d’Hebron, Universitat Autònoma de Barcelona, PROSICS. Barcelona, España;3. Unidad de Salud Internacional Vall d’Hebron-Drassanes, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, España;1. Department of Cardiac Surgery, Herz-Gefäss Chirurgie, UniversitätsSpital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland;2. Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Via Buonarroti 48, Milan 20145, Italy;1. Department of Cardiovascular Medicine, Catholic University, Rome, Italy;2. Department of Anatomy, Catholic University, Rome, Italy;1. Federation of Heart, Thorax and Vessels, Amiens University Hospital, Amiens, France;2. Department of Cardiology, Saint Quentin Hospital, Saint Quentin, France;1. Servicio de Microbiología, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain;2. Grupo de Estudio de Hepatitis Virales GEHEP-SEIMC;3. Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago IDIS, Santiago de Compostela, Spain;4. Servicio Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, UNICAN, Santander, Spain;5. Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain |
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| Abstract: | IntroductionMediastinitis is an infrequent but serious complication of cardiac surgery. Antimicrobial treatment guidelines are not well established. The aim was to describe the efficacy of sequential intravenous to oral therapy in selected post-surgical mediastinitis patients.MethodsA retrospective observational study including cases of mediastinitis after cardiac surgery, defined according to CDC criteria, at a third-level university hospital between January 2002 and December 2016. Sequential antimicrobial therapy was proposed in clinically stable patients. Rates of cure, relapse, and hospital stay were compared between patients who received sequential intravenous to oral therapy and those who received therapy exclusively by the intravenous route.ResultsEighty-one cases were included. Sequential intravenous to oral therapy was performed in 48 (59.3%) patients on median day 15. No differences in baseline characteristics or causal microorganisms were found between the two cohorts. The average duration of antibiotic therapy was 41.2 ± 10.09 days. The most commonly used drugs in sequential therapy were quinolones in 31 (64.6%) cases and rifampicin, always in association with another antibiotic, in 25 (52.1%). Hospital stay was shorter in the sequential therapy group (57.57 ± 34.03 vs. 84.35 ± 45.67; P = 0.007). Cure was achieved in 77 (92.8%) patients. Overall in-hospital mortality was less frequent in the group that received sequential therapy (2.1% vs. 15.2%; P = 0.039). There were no differences in relapse between the two cohorts (4.2% vs 9.1%; P = 0.366).ConclusionSequential antimicrobial treatment in selected patients with post-surgical mediastinitis may be as effective as exclusively intravenous treatment, reducing risks, hospital stay and associated costs. |
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| Keywords: | Sequential antimicrobial therapy Mediastinitis Surgical wound infection Cardiac surgery Tratamiento antimicrobiano secuencial Mediastinitis Infección de la herida quirúrgica Cirugía cardiaca |
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