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Ali M, Akram B, Bokhari MZ, Ahmed A, Anwar A, Talha M, Insaf Ahmed RA, Mehmood AM, Naseer B. Post-operative infections after cardiothoracic surgery and vascular procedures: a bibliometric and visual analysis of the 100 most-cited articles in the past 2 decades. GMS HYGIENE AND INFECTION CONTROL 2024; 19:Doc29. [PMID: 38883404 PMCID: PMC11177225 DOI: 10.3205/dgkh000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Aim To recognize and analyze the 100 most-cited articles on post-operative infections following cardiothoracic surgery and vascular procedures in the past 20 years. Methods Articles published on post-operative infections following cardiothoracic surgery and vascular procedures from inception 1986 till 2020 were reviewed and selected by two authors, based on their number of citations using the Scopus database. Their characteristics were recorded, i.e., title, authors, publication date, total no. of citations, citations per year (CPY), country of research, institutional affiliation, journal, research subject, and article type. Results The top 100 most influential articles were published between 1968 and 2017, with the peak in 2002. The mean number of total citations was 236.79 (range: 108-1,157). Areas with a medical focus were predominant in the studied research articles on the researched topic. The top-most journals in which these articles were published include Annals of Thoracic Surgery (14), followed by Circulation (8), and the New England Journal of Medicine (8). The number of publications affiliated with an institution were highest in the United States, with the Cleveland Clinic Foundation (6) having the most. Conclusion These findings highlight that there is a great potential to conduct research and publish the prevalence, causes, risk factors, pathogenesis and molecular biology of post-cardiac and -vascular surgery infections to prevent their adverse effects. The results can be taken into consideration for policy making to improve post-cardiac-surgery outcomes.
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Affiliation(s)
- Mohsan Ali
- King Edward Medical University, Lahore, Pakistan
| | - Bisma Akram
- MBBS Scholar, King Edward Medical University, Lahore, Pakistan
| | | | - Aleena Ahmed
- MBBS Scholar, King Edward Medical University, Lahore, Pakistan
| | - Amar Anwar
- King Edward Medical University, Lahore, Pakistan
| | - Muhammad Talha
- MBBS Scholar, Combined Military Hospital Medical College, Lahore, Pakistan
| | | | | | - Bisal Naseer
- King Edward Medical University, Lahore, Pakistan
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Gal DB, Cleveland JD, Kipps AK. Early Wound and Sternal Management Following Pediatric Cardiac Surgery. World J Pediatr Congenit Heart Surg 2024; 15:313-318. [PMID: 38263797 DOI: 10.1177/21501351231216448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Early postoperative wound management following congenital heart surgery remains an area without equipoise. Precautionary restrictions can impact quality of life, development, and delay access to other needed care. The influence of different practices on wound healing and complications is unknown. We surveyed Pediatric Acute Care Cardiology Collaborative member centers regarding postoperative wound closure, wound vacuum-assisted closure (VAC) use, sternal precautions, and restrictions in the early postoperative period. We analyzed responses using descriptive statistics. Responses were submitted by 35/46 (76%) centers. Most centers perform primary skin closure with subcutaneous sutures. Wound covers are removed after 48 h at 43% (15/35) of centers and after ≥72 h at 34% (12/35) of centers. For delayed sternal closure, 16 centers close skin with interrupted, externalized sutures, 5 utilize wound VAC-assisted closure, and 12 use variable practices. Generally, 33 centers use wound VACs for wound care. Patient selection for VAC use and length of therapy varies. We found great variability in duration of sternal precautions and in activity, bathing, and submersion restrictions. Finally, 29 centers require a waiting period between cardiothoracic surgery and other surgeries such as tracheostomy or gastrostomy tube placement. Postoperative wound and sternal management lack consistency across North American pediatric heart institutes. Some restrictive practices may prolong length of stay and/or negatively impact quality of life and neurodevelopment. Practices may also impact wound infection rates. Research linking practices with clinical outcomes is needed to better define standards of care and reduce potential negative consequences of overly conservative or aggressive practices.
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Affiliation(s)
- Dana B Gal
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - John D Cleveland
- Division of Pediatric Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
- Department of Cardiothoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alaina K Kipps
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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3
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Lemmet T, Mazzucotelli JP, Collange O, Fath L, Mutter D, Brigand C, Falcoz PE, Danion F, Lefebvre N, Bourne-Watrin M, Gerber V, Hoellinger B, Fabacher T, Hansmann Y, Ruch Y. Infectious Mediastinitis: A Retrospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae225. [PMID: 38751899 PMCID: PMC11095524 DOI: 10.1093/ofid/ofae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Background This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection. Methods This retrospective observational study enrolled patients who had mediastinitis diagnosed according to the criteria defined by the Centers for Disease Control and Prevention and were treated in Strasbourg University Hospital, France, between 1 January 2010 and 31 December 2020. Results We investigated 151 cases, including 63 cases of poststernotomy mediastinitis (PSM), 60 cases of mediastinitis due to esophageal perforation (MEP) and 17 cases of descending necrotizing mediastinitis (DNM). The mean patient age (standard deviation) was 63 (14.5) years, and 109 of 151 patients were male. Microbiological documentation varied according to the origin of the infection. When documented, PSM cases were mostly monomicrobial (36 of 53 cases [67.9%]) and involved staphylococci (36 of 53 [67.9%]), whereas MEP and DNM cases were mostly plurimicrobial (38 of 48 [79.2%] and 8 of 12 [66.7%], respectively) and involved digestive or oral flora microorganisms, respectively. The median duration of anti-infective treatment was 41 days (interquartile range, 21-56 days), and 122 of 151 patients (80.8%) benefited from early surgical management. The overall 1-year survival rate was estimated to be 64.8% (95% confidence interval, 56.6%-74.3%), but varied from 80.1% for DNM to 61.5% for MEP. Conclusions Mediastinitis represents a rare yet deadly infection. The present cohort study exhibited the different patterns observed according to the origin of the infection. Greater insight and knowledge on these differences may help guide the management of these complex infections, especially with respect to empirical anti-infective treatments.
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Affiliation(s)
- Thomas Lemmet
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | | | - Olivier Collange
- Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France
| | - Léa Fath
- Department of E.N.T. and Head and Neck Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Didier Mutter
- Department of Visceral and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - François Danion
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Bourne-Watrin
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Victor Gerber
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Baptiste Hoellinger
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Thibaut Fabacher
- Department of biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Yvon Ruch
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
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4
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Meinert ÉFRC, Kremer J, Tochtermann U, Sommer W, Warnecke G, Karck M, Meyer AL. Pericardial Closure With Expanded Polytetrafluoroethylene Patch in Left Ventricular Assist Device Surgery. ASAIO J 2024; 70:371-376. [PMID: 38153977 DOI: 10.1097/mat.0000000000002126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
To reduce adhesions after left ventricular assist device (LVAD) implantation, pericardial closure using an expanded polytetrafluoroethylene (ePTFE) patch has been suggested. However, as foreign material, ePTFE patches could increase the risk of infectious complications. In this single-center retrospective study, we investigated outcomes of pericardial closure using an ePTFE patch in LVAD implantation. We included all patients who underwent LVAD implantation at our center between 2011 and 2020 (n = 166). Primary endpoint was development of mediastinitis at any point of time between LVAD implantation and heart transplantation (HTx) or death. Secondary endpoint was overall survival. Preoperative and postoperative clinical data were collected to ensure comparability between the groups. We included 166 patients with LVAD. A total of 116 patients (70%) underwent pericardial closure using an ePTFE patch. There were significant differences between the groups in treatment setting, previous cardiac surgery, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level, development of driveline infection, and HTx. Patients with an ePTFE patch developed mediastinitis more frequently (16%) than patients without ePTFE patch (4%) ( p = 0.039). A significant difference in overall survival between the groups could not be confirmed ( p = 0.29). The use of PTFE patches for pericardial closure in LVAD implantation was associated with a higher incidence of mediastinitis, but not with a difference in overall survival.
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Affiliation(s)
- Étienne F R C Meinert
- From the Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
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5
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Kowalewski M, Kołodziejczak MM, Urbanowicz T, De Piero ME, Mariani S, Pasierski M, Makhoul M, Comanici M, Dąbrowski EJ, Matteucci M, Massimi G, Litwinowicz R, Kowalówka A, Wańha W, Jiritano F, Martucci G, Raffa GM, Malvindi PG, Kuźma Ł, Suwalski P, Lorusso R, Meani P, Lazar H. Regional antibiotic delivery for sternal wound infection prophylaxis a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2024; 14:9690. [PMID: 38678140 PMCID: PMC11055886 DOI: 10.1038/s41598-024-60242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
Despite evidence suggesting the benefit of prophylactic regional antibiotic delivery (RAD) to sternal edges during cardiac surgery, it is seldom performed in clinical practice. The value of topical vancomycin and gentamicin for sternal wound infections (SWI) prophylaxis was further questioned by recent studies including randomized controlled trials (RCTs). The aim of this systematic review and meta-analysis was to comprehensively assess the safety and effectiveness of RAD to reduce the risk of SWI.We screened multiple databases for RCTs assessing the effectiveness of RAD (vancomycin, gentamicin) in SWI prophylaxis. Random effects meta-analysis was performed. The primary endpoint was any SWI; other wound complications were also analysed. Odds Ratios served as the primary statistical analyses. Trial sequential analysis (TSA) was performed.Thirteen RCTs (N = 7,719 patients) were included. The odds of any SWI were significantly reduced by over 50% with any RAD: OR (95%CIs): 0.49 (0.35-0.68); p < 0.001 and consistently reduced in vancomycin (0.34 [0.18-0.64]; p < 0.001) and gentamicin (0.58 [0.39-0.86]; p = 0.007) groups (psubgroup = 0.15). Similarly, RAD reduced the odds of SWI in diabetic and non-diabetic patients (0.46 [0.32-0.65]; p < 0.001 and 0.60 [0.44-0.83]; p = 0.002 respectively). Cumulative Z-curve passed the TSA-adjusted boundary for SWIs suggesting adequate power has been met and no further trials are needed. RAD significantly reduced deep (0.60 [0.43-0.83]; p = 0.003) and superficial SWIs (0.54 [0.32-0.91]; p = 0.02). No differences were seen in mediastinitis and mortality, however, limited number of studies assessed these endpoints. There was no evidence of systemic toxicity, sternal dehiscence and resistant strains emergence. Both vancomycin and gentamicin reduced the odds of cultures outside their respective serum concentrations' activity: vancomycin against gram-negative strains: 0.20 (0.01-4.18) and gentamicin against gram-positive strains: 0.42 (0.28-0.62); P < 0.001. Regional antibiotic delivery is safe and effectively reduces the risk of SWI in cardiac surgery patients.
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Affiliation(s)
- Mariusz Kowalewski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland.
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Michalina M Kołodziejczak
- Department of Anaesthesiology and Intensive Care, Antoni Jurasz University Hospital No. 1, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznań University of Medical Sciences, Poznan, Poland
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maria Elena De Piero
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Michał Pasierski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maged Makhoul
- Department of Cardiac Surgery, Harefield Hospital, London, UK
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maria Comanici
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - Emil Julian Dąbrowski
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Matteo Matteucci
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Cardiac Surgery Unit, Department of Medicine and Surgery, ASST dei Sette Laghi, University of Insubria, Varese, Italy
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Giulio Massimi
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Cardiac Surgery Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Radosław Litwinowicz
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Adam Kowalówka
- Department of Cardiac Surgery, Faculty of Medical Sciences, Upper-Silesian Heart Center, Medical University of Silesia, Katowice, Poland
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Wojciech Wańha
- Department of Invasive Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Federica Jiritano
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo Per i trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti Delle Marche, Polytechnic University of Marche, Ancona, Italy
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137, 02-507, Warsaw, Poland
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Paolo Meani
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Policlinico, San Donato Milanese, Milan, Italy
- Thoracic Research Centre, Innovative Medical Forum, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Harold Lazar
- Boston University School of Medicine, Boston, MA, USA
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Crisafi C, Grant MC, Rea A, Morton-Bailey V, Gregory AJ, Arora RC, Chatterjee S, Lother SA, Cangut B, Engelman DT. Enhanced Recovery After Surgery Cardiac Society turnkey order set for surgical-site infection prevention: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00281-2. [PMID: 38574802 DOI: 10.1016/j.jtcvs.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Surgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients' quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery. METHODS Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type. RESULTS Preventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement. CONCLUSIONS Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.
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Affiliation(s)
- Cheryl Crisafi
- Heart & Vascular Program Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Md
| | - Amanda Rea
- Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md
| | | | - Alexander J Gregory
- Department of Anesthesiology, Cumming School of Medicine & Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rakesh C Arora
- Division of Cardiac Surgery, Department of Surgery, Harrington Heart and Vascular, Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | - Sylvain A Lother
- Sections of Infectious Diseases and Critical Care Rady Faculty of Health Sciences, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Busra Cangut
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel T Engelman
- Heart & Vascular Program Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
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7
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Grant AA, Moore C, Smith RN, Sciarretta JD, Sola R, Udobi K, Williams KN, Busby S, Butler C, Keeling B, Ghodsizad A, Nguyen J. Rigid Plate Fixation for Closure of Emergent Sternotomies for Trauma. Am Surg 2024; 90:648-654. [PMID: 37842929 DOI: 10.1177/00031348231206577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND No studies to date have evaluated the use of rigid plate fixation for emergent sternotomy in trauma patients. We evaluated our use of rigid plate fixation vs wire cerclage in patients requiring emergent sternotomy. We hypothesized there would be no difference in complications related to sternal closure between the two groups. METHODS We performed a retrospective cohort study to include all patients who underwent emergent sternotomy from 1/1/2018 to 1/31/2021 and survived to have their sternum closed. Outcomes in patients closed with wire cerclage group (WC) were compared to patients who underwent rigid plate fixation (RPF). RESULTS Twenty-two patients underwent emergent sternotomy. There were 11 patients in each group. There was no significant difference in admission demographics, ISS, or admission characteristics between the two groups. Complication rates related to closure (wound infection and hardware removal) were not significantly different (WC 27% vs RPF 9%, P = .58). Neither hospital length of stay (WC: 29 days vs RPF: 13 days, P = .13), ICU length of stay (WC: 6 days vs RPF: 7 days, P = .62), nor the number of ventilator days (WC: 3 days vs RPF: 1 day, P .11) were statistically different. All patients survived to discharge. DISCUSSION This is the first study comparing RPF and WC for sternotomy closure in the setting of trauma. We found no difference in the rate of wound related complications. This study demonstrates the feasibility of rigid plate fixation for trauma sternotomy closure and lays the foundation for future prospective studies.
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Affiliation(s)
- April A Grant
- Department of Surgery, Saint Alphonsus Regional Medical Center, Boise, ID, USA
| | - Cameron Moore
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- Department of Surgery at Grady, Emory University, Atlanta, GA, USA
| | | | - Richard Sola
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Surgery, Wellstar Health System, Marietta, GA
| | - Khadi Udobi
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Keneeshia N Williams
- Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA
- Department of Surgery, Wellstar Health System, Marietta, GA
| | | | - Caroline Butler
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Brent Keeling
- Emory University School of Medicine, Atlanta, GA, USA
| | - Ali Ghodsizad
- University of Miami School of Medicine, Miami, FL, USA
| | - Jonathan Nguyen
- Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA
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8
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Abfalterer H, Ruttmann-Ulmer E, Grimm M, Feuchtner G, Maier S, Ulmer H, Sandner S, Zimpfer D, Doenst T, Czerny M, Thielmann M, Böning A, Gaudino M, Siepe M, Bonaros N. Randomized comparison of HARVesting the Left Internal Thoracic Artery in a skeletonized versus pedicled technique: the HARVITA trial-study protocol. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae045. [PMID: 38514397 PMCID: PMC11021804 DOI: 10.1093/icvts/ivae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024]
Abstract
Latest research has indicated a potential adverse effect on graft patency rates and clinical outcomes with skeletonizing the left internal thoracic artery. We aim to provide a prospective, randomized, multicentre trial to compare skeletonized versus pedicled harvesting technique of left internal thoracic artery concerning graft patency rates and patient survival. A total of 1350 patients will be randomized to either skeletonized or pedicled harvesting technique and undergo surgical revascularization. Follow-up will be performed at 30 days, 1 year, 2 years and 5 years after surgery. The primary outcome will be death or left internal thoracic artery graft occlusion in coronary computed tomography angiography or invasive angiography within 2 years (+/- 3 months) after surgery. The secondary outcome will be major adverse cardiac events (composite outcome of all-cause death, myocardial infarction and repeated revascularization) within 1 year, 2 years and 5 years after surgery. The primary end point will be compared in the modified intention-to-treat population between the two treatment groups using Kaplan-Meier graphs, together with log-rank testing. Hereby, we present the study protocol of the first adequately powered prospective, randomized, multicentre trial which compares skeletonized and pedicled harvesting technique of left internal thoracic artery regarding graft patency rates and patient survival.
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Affiliation(s)
- Hannes Abfalterer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sarah Maier
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Graz, Graz, Austria
| | - Torsten Doenst
- Department of Cardiac Surgery, University of Jena, Jena, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart & Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Switzerland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Zhao Z, Ma D, Xu Y, Guo C, Li S, Wang J, Wang M, Qin Y, Liu H. Surgical therapy and outcome of descending necrotizing mediastinitis in Chinese: a single-center series. Front Med (Lausanne) 2024; 10:1337852. [PMID: 38274461 PMCID: PMC10808615 DOI: 10.3389/fmed.2023.1337852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background Descending Necrotizing Mediastinitis (DNM) is an acute and often fatal infection that affects the neck and mediastinum. DNM treatment consists of broad-spectrum antibiotics, early diagnosis, and surgical debridement with multidisciplinary cooperation. However, owing to the rarity and complexity of this disease, the mortality rate is high. This retrospective study analyzed a single-center experience of managing DNM in Chinese patients over the last 10 years. Methods A single-center, retrospective, observational, and descriptive study was conducted on 31 patients with DNM at Peking Union Medical College Hospital from 2012 to 2022. Case report forms were used to collect data which were then analyzed with a focus on surgical management and outcomes. Results This study examined the outcomes of 31 patients diagnosed with DNM at our hospital. The most common comorbidities on admission were hypertension (48%) and diabetes mellitus (42%). The degree of diffusion of DNM according to Endo's classification was classified as follows: type I in 7 patients (22.6%), type IIA in 5 (16.1%), and type IIB in 19 patients (61.3%). Among these patients, 13 (41.9%) were found to have a single microbial infection, while 16 (51.6%) were found to have polymicrobial infections. In all cases, neck drainage was performed via cervicotomy, with multiple drains (64.5%) and vacuum sealing drainage (VSD) (35.5%). Mediastinal drainage was performed via a cervical mediastinotomy (51.6%), video-assisted thoracic surgery (VATS) (41.9%), or thoracotomy (6.5%). The 30-day mortality rate was 25.8% and 24.0 days of the average length of hospital stay. Conclusion Early accurate diagnosis and timely intervention have been shown to be correlated with a positive prognosis. Cervicothoracic CT (computed tomography) is essential for the diagnosis, staging, and evaluation of the optimal surgical treatment. Cervicotomy and video-assisted thoracoscopic surgery with percutaneous drainage is effective, even in advanced cases. Additionally, the application of VSD in cervical incision did not improve prognosis but may shorten the length of ICU (intensive care unit) and hospital stays.
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Affiliation(s)
- Zhewei Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Wang
- Department of ENT, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mu Wang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Eraqi M, Diab AH, Matschke K, Alexiou K. Confirmation of Safety of Titanium Wire in Sternotomy Closure, A Randomized Prospective Study. Thorac Cardiovasc Surg 2024; 72:70-76. [PMID: 36918153 PMCID: PMC10786665 DOI: 10.1055/s-0043-1764315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/26/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND There are many factors that are known to increase the risk of sternal wound infection (SWI); some studies have reported that nickel is a risk factor for SWI. Titanium wires have only been used as an alternative to steel wires in patients with known allergy to nickel. However, there is a paucity of literature regarding the safety of using titanium wires compared to that on the safety of steel wires for sternum closure after cardiac surgery. Therefore, this study aimed to demonstrate the noninferiority of titanium wires, even in patients without a known allergy. METHODS A total of 322 patients who underwent elective full median sternotomy were randomly assigned to sternal closure either by titanium wires (n = 161) or by stainless steel wires. RESULTS Fourteen patients had sternal instability, six (3.7%) patients in the titanium group and eight (5%) patients in the stainless steel group (p = 0.585). There was no statistically significant difference between both groups in terms of postoperative wound infection (p = 0.147). Patients in the titanium group experienced statistically significant lower postoperative pain than those in the stainless steel group (p = 0.024). The wire type was not an independent risk factor for SI, as shown by univariate and logistic regression analyses. CONCLUSION Titanium wires are a good alternative and have been proven to be safe and effective for sternal closure. The surgeon should be aware of the possibility of developing an allergic reaction to the wires, especially in patients with previous multiple allergic histories.
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Affiliation(s)
- Mohamed Eraqi
- Klinikum Bayreuth GmbH, Bayreuth, Germany
- Department of Cardiac Surgery, Heart Center Dresden at the University Hospital Carl Gustav Carus, Dresden, Germany
| | - Abdel Hannan Diab
- Department of Cardiac Surgery, Heart Center Dresden at the University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, Heart Center Dresden at the University Hospital Carl Gustav Carus, Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, Heart Center Dresden at the University Hospital Carl Gustav Carus, Dresden, Germany
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11
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Kawamura A, Yoshioka D, Kawamura M, Kawamura T, Shijo T, Maeda K, Matsuura R, Yamashita K, Misumi Y, Matsumoto R, Shimamura K, Miyagawa S. The usefulness of chest drain and epicardial pacing wire culture for diagnosing mediastinitis after open-heart surgery. Surg Today 2024; 54:73-79. [PMID: 37490071 DOI: 10.1007/s00595-023-02720-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/18/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Culture of extracted drains or epicardial pacing wires is an easy and noninvasive method for detecting mediastinitis after open-heart surgery, although studies on its sensitivity and specificity are limited. We, therefore, investigated the usefulness of this approach for diagnosing mediastinitis. METHODS We retrospectively studied the culture results of drains and epicardial pacing wires extracted from 3308 patients. Prediction models of mediastinitis with and without culture results added to clinical risk factors identified by a logistic regression analysis were compared. RESULTS The incidence of mediastinitis requiring surgery was 1.89% (n = 64). Staphylococcus was the causative bacterium in 64.0% of cases. The sensitivity, specificity, and positive and negative predictive values of positive culture results were 50.8%, 91.8%, 10.7%, and 99.0%, respectively. Methicillin-resistant Staphylococcus aureus had the highest positive predictive value (61.5%). A multivariate analysis identified preoperative hemodialysis (OR 5.40 [2.54-11.5], p < 0.01), long operative duration (p < 0.01), postoperative hemodialysis (OR 2.25 [1.01-4.98], p < 0.05), and positive culture result (OR 10.2 [5.88-17.7], p < 0.01) as independent risk factors. The addition of culture results to pre- and postoperative hemodialysis and a lengthy operative time improved the prediction of mediastinitis. CONCLUSIONS A culture survey using extracted drains and epicardial pacing wires may provide useful information for diagnosing mediastinitis.
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Affiliation(s)
- Ai Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan.
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Takuji Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Koichi Maeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Ryohei Matsuura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Yuske Misumi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Ryota Matsumoto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
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12
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Fernández AM, Ruiz E, Cantador B, González FJ, Baamonde C, Álvarez A. Case Report of Complex Chest Wall Repair for Sternal Dehiscence After Bilateral Lung Transplantation. Transplant Proc 2023; 55:2307-2308. [PMID: 37798166 DOI: 10.1016/j.transproceed.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND We report a case of a complex chest wall reconstruction because of sternal dehiscence, requiring different surgical procedures for its complete resolution. CASE REPORT A 54-year-old man patient with Langerhans cell histiocytosis and chronic obstructive pulmonary disease underwent bilateral sequential lung transplantation through a clamshell incision, using nitinol thermo-reactive clips for sternal closure. One year later, he consulted because of chest pain, fever, and purulent secretions. Physical examination and chest X-ray revealed a right pulmonary hernia due to post-clamshell wound dehiscence. Chest wall repair was performed, placing an expanded-polytetrafluoroethylene synthetic mesh, and the sternum was realigned and fixated with titanium plates and screws. However, in the immediate postoperative period, there was a large amount of serous drainage through the surgical wound, needing negative pressure therapy. Unfortunately, the wound became necrotic with exposure to the osteosynthesis material. In addition, a chest computed tomography scan showed fluid accumulation in the anterior chest wall. Therefore, two-stage revision surgery was indicated: first, the removal of the previous prosthesis and, the definite one, the use of a pedicled latissimus dorsi myocutaneous flap to provide effective coverage of the wound. CONCLUSION Sternal dehiscence is not an uncommon complication after clamshell incision in patients undergoing bilateral sequential lung transplantation, and it is associated with significant morbidity. In the presence of chest wall instability, surgical repair is mandatory.
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Affiliation(s)
- Alba María Fernández
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Eloísa Ruiz
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Benito Cantador
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Francisco Javier González
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Carlos Baamonde
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain
| | - Antonio Álvarez
- Thoracic Surgery and Lung Transplantation Department, Reina Sofía University Hospital, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba (IMIBIC), University of Córdoba, Spain.
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13
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Lee DY, Eo S, Lim S, Yoon JS. Successful pedicled vertical rectus abdominis myocutaneous flap reconstruction with negative-pressure wound therapy for deep sternal wound infection: a case report and comprehensive review. Front Surg 2023; 10:1268555. [PMID: 38026493 PMCID: PMC10657836 DOI: 10.3389/fsurg.2023.1268555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Deep sternal wound infection (DSWI) is a serious complication that may occur after median sternotomy, with potentially devastating consequences. By reporting our case and analyzing the existing literature, this article aimed to provide a thorough understanding of the role of negative-pressure wound therapy (NPWT) and the importance of flap choice in managing DSWI accompanied by severe heart injury and high hemodynamic risk. Case description A 60-year-old woman with severe aortic stenosis, aortic valve regurgitation, and heart failure underwent redo sternotomy, which resulted in an intraoperative right ventricle injury. She required extracorporeal membrane oxygenation support because of low blood pressure and subsequently developed complications, including surgical site hematoma, wound dehiscence, and fat necrosis. She was referred for wound closure, where a significant 10 × 20-cm soft tissue defect in the anterior chest wall was observed. A pedicled vertical rectus abdominis myocutaneous flap addressed the soft tissue defect. The wound showed remarkable improvement at the 8-month follow-up visit. Conclusions DSWI management is a complex and multifaceted challenge. NPWT, when combined with appropriate surgical strategies, including wound debridement and flap selection, may promote successful wound healing. This case report highlights the successful management of a complex DSWI using a multidisciplinary approach, including debridement, appropriate antibiotic therapy, and free-flap reconstruction, which resulted in favorable outcomes.
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Affiliation(s)
| | | | | | - Jung Soo Yoon
- Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, Seoul, Republic of Korea
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14
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Wang W, Lee J, Chiang K, Chiou S, Wang C, Wu S. The role of negative pressure wound therapy in the treatment of poststernotomy mediastinitis in Asians: A single-center, retrospective cohort study. Health Sci Rep 2023; 6:e1675. [PMID: 38028682 PMCID: PMC10644291 DOI: 10.1002/hsr2.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Poststernotomy mediastinitis (PSM) is a critical and life-threatening complication that can arise after cardiac surgery. The aim of this study was to evaluate and compare the outcomes of negative pressure wound therapy (NPWT) and conventional methods in the management of mediastinitis following heart surgery with a focus on Asian populations. Methods For this retrospective study, we included and evaluated a total of 34 patients who had undergone cardiac operations between January 2011 and September 2021 and developed PSM. The patients were divided into two groups, the NPWT group (n = 16, 47.1%) and the conventional treatment group (n = 18, 52.9%), and compared. Results The two groups showed no significant differences in terms of patient characteristics, PSM wound classification based on the El Oakley classification, and wound closure methods, but there was a higher incidence of diabetes mellitus in the NPWT group. With regard to mediastinal cultures, a higher prevalence of Staphylococcus epidermidis was observed in the NPWT group. However, we found no significant differences between the two groups regarding the time interval from diagnosis to wound closure, hospitalization duration, and re-exploration rate. Notably, the NPWT group exhibited a significantly higher in-hospital mortality rate than the conventional treatment group (p = 0.024). Conclusions Our findings suggest that the use of NPWT might not lead to improved medical outcomes for patients with PSM when compared to conventional treatment methods. As a result, it becomes imperative to exercise great care when choosing patients for NPWT. To obtain more definitive and conclusive results and identify the most appropriate cases for NPWT, conducting larger randomized clinical trials is necessary.
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Affiliation(s)
- Wei‐Ting Wang
- Department of Internal Medicine, Division of CardiologyTaipei Veterans General HospitalTaipeiTaiwan
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of Clinical MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jui‐Min Lee
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Surgery, Division of Plastic and Reconstructive SurgeryTaipei Veterans General HospitalTaipeiTaiwan
| | - Kuan‐Ju Chiang
- Division of Plastic SurgeryTaipei Medical University – Shuang Ho HospitalNew Taipei CityTaiwan
| | - Shih‐Hwa Chiou
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of Clinical MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chin‐Tien Wang
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Institute of Clinical MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Szu‐Hsien Wu
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Department of Surgery, Division of Plastic and Reconstructive SurgeryTaipei Veterans General HospitalTaipeiTaiwan
- Department of Surgery, National Defense Medical CenterDivision of Plastic SurgeryTaipeiTaiwan
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15
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Song Y, Chu W, Zhang M, Liu Z, Li D, Zhao F, Zhang B, Gao M, Yuan H, Shen C. A study on the preoperative risk factors for primary healing failure in the reconstruction of deep sternal wound infection with platelet-rich plasma and negative pressure trauma therapy. Int Wound J 2023; 20:3457-3466. [PMID: 37269235 PMCID: PMC10588312 DOI: 10.1111/iwj.14216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/05/2023] Open
Abstract
Deep sternal wound infection (DSWI) is a relatively complex wound in wound reconstruction surgery. Because plastic surgeons deal with DSWI patients late. The primary healing (healing by first intention) after reconstruction of DSWI is restricted by many preoperative risk factors. The purpose of this study is to explore and analyse the risk factors of primary healing failure in patients with DSWI treated with platelet-rich plasma (PRP) and negative pressure trauma therapy (NPWT). 115 DSWI patients treated with the PRP and NPWT (PRP + NPWT) modality were retrospectively (2013-2021) analysed. They were divided into two groups according to primary healing results after the first PRP + NPWT treatment. Univariate and multivariate analyses were used to compare the data of the two groups to find out the risk factors and their optimal cut-off values were identified by ROC analysis. The primary healing results, debridement history, wound size, sinus, osteomyelitis, renal function, bacterial culture, albumin (ALB), platelet (PLT) between the two groups were significantly different (P < 0.05). Binary logistic regression showed that osteomyelitis, sinus, ALB and PLT were the risk factors affecting primary healing outcomes (P < 0.05). ROC analysis showed that AUC for ALB in the non-primary healing group was 0.743 (95% CI: 0.650-0.836, P < 0.05) and its optimal cutoff value of 31 g/L was associated with primary healing failure with a sensitivity of 96.9% and specificity of 45.1%. AUC for PLT in the non-primary healing group was 0.670 (95% CI: 0.571 ~ 0.770, P < 0.05) its optimal cutoff value of 293 × 109 /L was associated with primary healing failure with a sensitivity of 72.5% and specificity of 56.3%. In the cases included in this study, the success rate of primary healing of DSWI treated with PRP + NPWT was not affected by the most common preoperative risk factors for wound non-union. It is indirectly confirmed that PRP + NPWT is an ideal treatment. However, it should be noted that it will still be adversely affected by sinus osteomyelitis, ALB and PLT. The patients need to be carefully evaluated and corrected before reconstruction.
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Affiliation(s)
- Yaoyao Song
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Wanli Chu
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Ming Zhang
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Zhaoxing Liu
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Dawei Li
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Fan Zhao
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Bohan Zhang
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Mengmeng Gao
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Huageng Yuan
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
| | - Chuanan Shen
- Department of Burns and Plastic SurgeryFourth Medical Center of Chinese PLA General Hospital, (PLA:People's Liberation Army)BeijingChina
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16
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Yang X, Fu J, Zhang S. The effect of the multiple arterial grafts compared with single arterial graft for coronary artery bypass grafting on sternal wound complications: A meta-analysis. Int Wound J 2023; 20:3249-3254. [PMID: 37132096 PMCID: PMC10502291 DOI: 10.1111/iwj.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
A meta-analysis investigation was executed to measure the influence of multiple arterial grafts (MAGs) compared with single arterial graft (SAG) for coronary artery bypass grafting (CABG) on sternal wound complications (SWCs). A comprehensive literature inspection till February 2023 was applied and 1048 interrelated investigations were reviewed. The seven chosen investigations enclosed 11 201 individuals with CABG in the chosen investigations' starting point, 4870 of them were using MAGs, and 6331 were using SAG. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilised to compute the value of the effect of the MAGs compared with SAG for CABG on SWCs by the dichotomous approaches and a fixed or random model. MAGs had significantly higher SWC (OR, 1.38; 95% CI, 1.10-1.73, P = .005) compared with those with SAG in CABG. MAGs had significantly higher SWC compared with those with SAG in CABG. However, care must be exercised when dealing with its values because of the low number of selected investigations for the meta-analysis.
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Affiliation(s)
- Xin Yang
- Department of Cardiothoracic Surgerythe First College of Clinical Medical Science, China Three Gorges UniversityYichangHubeiChina
- Department of Cardiothoracic SurgeryYichang Central People's HospitalYichangHubeiChina
| | - Juan Fu
- Department of Oncologythe Second People's Hospital of China Three Gorges UniversityYichangHubeiChina
- Department of OncologyYichang Second People's HospitalYichangHubeiChina
| | - Songlin Zhang
- Department of Cardiothoracic Surgerythe First College of Clinical Medical Science, China Three Gorges UniversityYichangHubeiChina
- Department of Cardiothoracic SurgeryYichang Central People's HospitalYichangHubeiChina
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17
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Yamamoto H, Isogai J. Transient constrictive pericarditis following coxsackievirus A4 infection as a rare cause of acute mediastinitis: A case report. Heliyon 2023; 9:e19555. [PMID: 37809423 PMCID: PMC10558803 DOI: 10.1016/j.heliyon.2023.e19555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background Transient constrictive pericarditis (TCP) is a distinct constrictive pericarditis (CP) subtype characterized by acute pericardial inflammation and transient constrictive physiology. If left untreated, it may progress to irreversible CP requiring pericardiectomy. However, making an early diagnosis of TCP remains difficult. Case presentation A 51-year-old man presented with fever, chest pain, and dyspnea following preceding flu symptoms. An initial investigation suggested right-sided heart failure. Laboratory results revealed elevated inflammatory markers and hepatic enzyme levels. Echocardiography revealed pericardial effusion with a normal ejection fraction and diastolic ventricular septal bounce suggestive of pericardial constriction. Computed tomography suggested acute descending mediastinitis with pericarditis and pleuritis; however, detailed examinations ruled out this possibility. The constellation of increased serological inflammation, pericardial thickness/effusion, and constrictive physiology suggested TCP, confirmed by cardiac magnetic resonance (CMR) and hemodynamic studies. CMR also revealed coexistent myocarditis. After a thorough assessment for the cause of TCP, a viral etiology was suspected. Paired serology for virus antibody titers revealed a significant increase only in coxsackievirus A4 (CVA4) titers. With prompt anti-inflammatory treatment, the patient's pericardial structure and function and concomitant inflammation of the surrounding tissues were nearly completely recovered, leading to a final diagnosis of TCP caused by CVA4. The subsequent clinical course was uneventful without recurrence at the 1-year follow-up. Conclusions Here we described the first case of TCP caused by CVA4 concurrent with mediastinitis, myocarditis, and pleuritis, all of which were successfully resolved with anti-inflammatory treatment. Acute mediastinitis secondary to TCP is rare. This case highlights the clinical importance of assessing pericardial diseases as a source of acute mediastinitis and considering CVA4 as an etiology of TCP. An evaluation including multimodal cardiac imaging and serology for virus antibody titers may be useful for an exploratory diagnosis of TCP in right-sided heart failure patients with pericardial effusion.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Jun Isogai
- Division of Radiology, Asahi General Hospital, Asahi, Japan
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18
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Demirsoy E, Mavioglu I, Dogan E, Gulmez H, Dindar I, Erol MK. The Feasibility and Early Results of Multivessel Minimally Invasive Coronary Artery Bypass Grafting for All Comers. J Clin Med 2023; 12:5663. [PMID: 37685730 PMCID: PMC10488478 DOI: 10.3390/jcm12175663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES Cardiovascular surgery advancements have emerged with various minimally invasive approaches for treating multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. We present our clinical experience and minimally invasive coronary bypass techniques through minithoracotomy, which we apply without selection to patients who have decided to have elective surgery for multivessel isolated coronary artery disease. METHODS It consists of 230 consecutive patients operated by the same team with this method between July 2020 and September 2022. The patients were assigned to one of the two methods preoperatively to their accompanying comorbidities and operated on either with blood cardioplegia via 5 to 7 cm left anterior minithoracotomy, with on-pump clamped technique or without pump via left anterolateral minithoracotomy. RESULTS Mortality was observed in two of our patients (0.9%), but myocardial infarction was not observed in our patients in the early postoperative period. None of our patients required conversion to sternotomy (0%). Five patients' needed reoperation from the same incision due to postoperative bleeding (2.2%), and atrial fibrillation developed in 17 patients in the postoperative period (7.4%). The mean number of bypasses was found to be 3.0 ± 0.9. CONCLUSIONS Minimally invasive coronary artery bypass surgery via minithoracotomy can be routinely reproduced safely. More long-term results and more multicenter studies are needed for more widespread acceptance of the technique.
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Affiliation(s)
- Ergun Demirsoy
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Ilhan Mavioglu
- Division of Cardiovascular Surgery, Private Practice, Sisli, 34394 Istanbul, Turkey;
| | - Emre Dogan
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Harun Gulmez
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Ismet Dindar
- Division of Cardiology, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
| | - Mustafa Kemal Erol
- Division of Cardiology, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
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19
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Carnero-Alcázar M, Beltrao-Sial R, Montero-Cruces L, López-Vyzcaino M, Pérez-Camargo D, Sánchez R, Cobiella-Carnicer J, Fernández-Velasco D, Maroto-Castellanos LC. Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad143. [PMID: 37607006 PMCID: PMC10460483 DOI: 10.1093/icvts/ivad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES We aimed at comparing the risk of major adverse events and length of stay between patients undergoing ultrafast track and conventional fast track. METHODS Retrospective cohort study adjusted by propensity score matching, including patients operated on between March 2020 and December 2022 of any of the following: coronary, valve surgery or ascending aorta surgery. Patients were divided into 2 groups: ultrafast track: extubation in the operating room and fast track: extubation attempted in the first 6 postoperative hours. The primary objective was to compare the risk of the combined event death, lung respiratory outcomes (reintubation, mechanical ventilation longer than 24 h or pneumonia), or acute renal failure. RESULTS A total of 1126 patients were included. A total of 579 (51.4%) were extubated in the operating room. A total of 331 pairs were available after matching by propensity score. The risk of the primary outcome was 11.8% (n = 39) in the fast-track group and 6.3% (n = 21) in the ultrafast-track group (P = 0.013), mostly driven by lung adverse events (6.9% vs 2.4%, P = 0.011) while no significant differences were detected in the risk of death (2.4% vs 1.8%, P = 0.77) or acute renal failure (8% vs 6.3%, P = 0.56). The risk of myocardial infarction was higher in the fast-track group (2.7% vs 0%, P = 0.039). The median length of stay in the postoperative intensive care unit was longer in the fast-track group [24.7 h (interquartile range 21.5; 62.9) vs 23.5 h (interquartile range 22; 46), P = 0.015]. CONCLUSIONS In patients undergoing cardiac surgery, extubation in the operating room is associated to a lower risk of postoperative complications (mostly driven by lung adverse events) and length of stay in intensive care unit as compared to fast track.
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Affiliation(s)
| | - Rosa Beltrao-Sial
- Department of Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Rubén Sánchez
- Department of Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Luis C Maroto-Castellanos
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University, Madrid, Spain
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20
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Ammannaya GKK. Successful management of penetrating cardiac injury in a limited resource setting without cardiac surgical instruments and heart-lung machine. J Surg Case Rep 2023; 2023:rjad473. [PMID: 37593188 PMCID: PMC10431200 DOI: 10.1093/jscr/rjad473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023] Open
Abstract
Penetrating cardiac injuries (PCI) are often fatal and do not present enough time for effective referrals to higher centers. Most deaths occur in transit from a remote healthcare setting with limited resources. I present the first reported case of PCI in the medical literature to be managed successfully in the absence of heart-lung machine as well as dedicated cardiac surgical instruments and equipment, and which was further complicated by mediastinitis.
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Affiliation(s)
- Ganesh Kumar K Ammannaya
- Department of Cardiovascular & Thoracic Surgery, Accord Multispeciality Hospital, Bhuj, Gujarat 370001, India
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21
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Downing M, Modrow M, Thompson-Brazill KA, Ledford JE, Harr CD, Williams JB. Eliminating sternal wound infections: Why every cardiac surgery program needs an I hate infections team. JTCVS Tech 2023; 19:93-103. [PMID: 37324338 PMCID: PMC10268509 DOI: 10.1016/j.xjtc.2023.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives The majority of studies examining deep sternal wound infection (DSWI) prevention focus on ameliorating 1 variable at a time. There is a paucity of data regarding the synergistic effects of combining clinical and environmental interventions. This article describes an interdisciplinary, multimodal approach to eliminate DSWIs at a large community hospital. Methods We developed a robust, multidisciplinary infection prevention team to evaluate and act in all phases of perioperative care to achieve a cardiac surgery DSWI rate of 0, named: the I hate infections team. The team identified opportunities for improved care and best practices and implemented changes on an ongoing basis. Results Patient-related interventions consisted of preoperative methicillin-resistant Staphylococcus aureus identification, individualized perioperative antibiotics, antimicrobial dosing strategies, and maintenance of normothermia. Operative-related interventions involved glycemic control, sternal adhesives, medications and hemostasis, rigid sternal fixation for high-risk patients, chlorhexidine gluconate dressings over invasive lines, and use of disposable health care equipment. Environment-related interventions included optimizing operating room ventilation and terminal cleaning, reducing airborne particle counts, and decreasing foot traffic. Together, these interventions reduced the DSWI incidence from 1.6% preintervention to 0% for 12 consecutive months after full bundle implementation. Conclusions A multidisciplinary team focused on eliminating DSWI identified known risk factors and implemented evidence-based interventions in each phase of care to ameliorate risk. Although the influence of each individual intervention on DSWI remains unknown, use of the bundled infection prevention approach reduced the incidence to 0 for the first 12 months after implementation.
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Affiliation(s)
- Maren Downing
- WakeMed Health and Hospitals, Raleigh, NC
- Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Michael Modrow
- WakeMed Health and Hospitals, Raleigh, NC
- Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NC
| | - Kelly A. Thompson-Brazill
- WakeMed Health and Hospitals, Raleigh, NC
- Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NC
| | - J. Erin Ledford
- WakeMed Health and Hospitals, Raleigh, NC
- Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NC
| | - Charles D. Harr
- WakeMed Health and Hospitals, Raleigh, NC
- Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NC
| | - Judson B. Williams
- WakeMed Health and Hospitals, Raleigh, NC
- Department of Cardiovascular and Thoracic Surgery, WakeMed Heart and Vascular, Raleigh, NC
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22
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Papalexis N, Peta G, Vara G, Spinnato P, Errani C, Martella C, Miceli M, Facchini G. Palliative Arterial Embolization for Metastases of the Sternum. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03459-1. [PMID: 37188897 DOI: 10.1007/s00270-023-03459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND To investigate the safety and efficacy of palliative arterial embolization for metastases of the sternum. MATERIALS AND METHODS This study included 10 consecutive patients (5 M, 5 F; mean age 58.1; range 37-70) with metastases of the sternum from different primary tumors, treated with palliative arterial embolization using NBCA-Lipiodol between January 2007 and June 2022. Four patients received a second embolization at the same site, for a total of 14 embolizations. Data on technical and clinical success, as well as changes in tumor size, were collected. All embolization-related complications were evaluated according to the CIRSE classification system for complications. RESULTS Post-embolization angiography showed occlusion of more than 90% of the pathological feeding vessels in all procedures. Pain score and analgesic drug consumption were reduced by 50% in all 10 patients (100%, p < 0.05). The mean duration of pain relief was 9.5 months (range 8 to 12 months, p < 0.05). Metastatic tumor size was reduced from a mean of 71.5 cm3 (range 41.6 to 90.3 cm3) pre-embolization to a mean of 67.9 cm3 (range 38.5 to 86.1 cm3) at the 12-month follow-up (p < 0.05). None of the patients experienced embolization-related complications. CONCLUSION Arterial embolization is safe and effective as a palliative treatment for patients with metastases of the sternum who did not benefit from radiation therapy or experienced recurrence in symptoms.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Vara
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Martella
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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23
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Pachar Flores MR, Andrade-Alegre R, Santiago E, Sierra L. Descending Necrotizing Mediastinitis by Streptococcus anginosus and Prevotella buccae in an Intensive Care Unit Patient: A Case Report. Cureus 2023; 15:e39703. [PMID: 37398802 PMCID: PMC10309078 DOI: 10.7759/cureus.39703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Necrotizing infections of deep neck spaces are a group of life-threatening infectious diseases acquired through trauma or as a descending infection from an odontogenic source. The isolation of pathogens is unusual because of the anaerobic nature of the infection; however, one way to achieve this is through the use of automated microbiological methods like matrix-assisted laser desorption/ionization and time-of-flight (MALDI-TOF) following standard microbiology protocols for analyzing samples from potential anaerobic infections. We present a case of a patient without risk factors for descending necrotizing mediastinitis with isolation of Streptococcus anginosus and Prevotella buccae managed at the intensive care unit with a multidisciplinary team. We present our approach and how we successfully treat this complicated infection.
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Affiliation(s)
- Monica R Pachar Flores
- Infectious Diseases, Hospital Santo Tomas, Panama, PAN
- Infectious Diseases, Instituto Oncologico Nacional, Panama, PAN
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24
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Fever of Unknown Origin in a 6-Year-old. Pediatr Infect Dis J 2023; 42:172-174. [PMID: 36638408 DOI: 10.1097/inf.0000000000003686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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25
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Hariri G, Genoud M, Bruckert V, Chosidow S, Guérot E, Kimmoun A, Nesseler N, Besnier E, Daviaud F, Lagier D, Imbault J, Grimaldi D, Bouglé A, Mongardon N. Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome. Crit Care 2023; 27:6. [PMID: 36609390 PMCID: PMC9817255 DOI: 10.1186/s13054-022-04277-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. METHODS Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009-2019). RESULTS Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17-61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43-65] vs. 65 [61-73] yo; p = 0.013), had lower body mass index (24 [20-26] vs. 30 [24-32] kg/m2; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28-40] vs. 54 [34-61]; p = 0.012). CONCLUSION Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.
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Affiliation(s)
- Geoffroy Hariri
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.462844.80000 0001 2308 1657Institut Pierre Louis d’épidémiologie et de santé publique, Inserm U1136, Sorbonne Université, 75013 Paris, France
| | - Mathieu Genoud
- grid.150338.c0000 0001 0721 9812Service des urgences, Département de médecine aiguë, Hôpitaux Universitaires de Genève, 1205 Geneva, Switzerland
| | - Vincent Bruckert
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France ,grid.410528.a0000 0001 2322 4179Service d’anesthésie-réanimation, CHU de Nice, 06000 Nice, France
| | - Samuel Chosidow
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France
| | - Emmanuel Guérot
- grid.414093.b0000 0001 2183 5849Médecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Antoine Kimmoun
- grid.29172.3f0000 0001 2194 6418CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine, 54000 Nancy, France
| | - Nicolas Nesseler
- grid.411154.40000 0001 2175 0984Service d’anesthésie-réanimation, CHU de Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284CHU de Rennes, Inra, Inserm, Institut NUMECAN – UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d’Investigation Clinique de Rennes), Univ Rennes, 35000 Rennes, France
| | - Emmanuel Besnier
- grid.41724.340000 0001 2296 5231Département d’anesthésie-réanimation, CHU de Rouen, 76000 Rouen, France ,grid.412043.00000 0001 2186 4076UNIROUEN, Inserm U1096, Normandie Univ, 76000 Rouen, France
| | - Fabrice Daviaud
- grid.417818.30000 0001 2204 4950Service de réanimation, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - David Lagier
- grid.411266.60000 0001 0404 1115Service d’anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13000 Marseille, France
| | - Julien Imbault
- grid.42399.350000 0004 0593 7118Service d’anesthésie réanimation sud, centre médico-chirurgical Magellan, CHU de Bordeaux, 33600 Pessac, France ,grid.412041.20000 0001 2106 639XInserm, UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, 33000 Bordeaux, France
| | - David Grimaldi
- Service de réanimation polyvalente, Hôpital Erasme, cliniques universitaires de Bruxelles, 1070 Brussels, Belgium
| | - Adrien Bouglé
- grid.462844.80000 0001 2308 1657Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | - Nicolas Mongardon
- grid.412116.10000 0004 1799 3934Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000 Créteil, France ,grid.428547.80000 0001 2169 3027U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700 Maisons-Alfort, France ,grid.410511.00000 0001 2149 7878Faculté de Santé, Univ Paris Est Créteil, 94010 Créteil, France
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Li Y, Zhu Y, Wan C, Wen Y. Staphylococcus aureus bacteremia complicated with non-traumatic mediastinal abscess in children: A case report. Front Pediatr 2023; 11:1115788. [PMID: 36925664 PMCID: PMC10011612 DOI: 10.3389/fped.2023.1115788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
Background Staphylococcus aureus bacteremia complicated with non-traumatic mediastinal abscess rarely occurs in children. Herein, we report a case of S. aureus bacteremia in a previously healthy 15-month-old boy, which was complicated with a non-traumatic mediastinal abscess, followed by recovery without surgery. Case presentation A previously healthy 15-month-old boy presented to the hospital with a high fever, accompanied by chills, lethargy, tachycardia, tachypnea, and slight cough. Contrast-enhanced computerized tomography revealed mediastinal abscess and blood culture analysis showed the presence of S. aureus which was methicillin-susceptible. With prompt initiation of antibiotic treatment, with appropriate duration, the patient successfully recovered without surgical drainage upon discharge. Conclusions Staphylococcus aureus bacteremia complicated with non-traumatic mediastinal abscess is rare in children, and early recognition and appropriate management are essential for a successful outcome.
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Affiliation(s)
- Yiyuan Li
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yu Zhu
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Chaomin Wan
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yang Wen
- Key Laboratory of Women and Children Diseases, Department of Pediatrics, West China Second University Hospital, Sichuan University, Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Hosokawa T, Tanami Y, Sato Y, Deguchi K, Takei H, Oguma E. Role of ultrasound in the treatment of pediatric infectious diseases: case series and narrative review. World J Pediatr 2023; 19:20-34. [PMID: 36129633 PMCID: PMC9490683 DOI: 10.1007/s12519-022-00606-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/05/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Infectious diseases are common in pediatric patients. In these patients, ultrasound is a useful imaging modality that involves no irradiation or sedation and can be performed repeatedly at the patient's bedside. The purpose of this review was to show pediatric cases with infectious disease that used ultrasound to decide the methods of treatment. DATA SOURCES Literature review was performed using Pubmed as the medical database source. No year-of-publication restriction was placed. The mesh terms used were: "ultrasound", "sonography", "infectious disease", "treatment", "antibiotics", "surgical intervention", "pediatric", "children", "deep neck abscess", "pyothorax", "empyema", "pneumonia", "urinary tract infection", "intra-abdominal abscess", "soft tissue infection", "septic arthritis", "osteomyelitis", and "surgical site infection". RESULTS We presented pediatric case series with infectious diseases, including deep neck abscess, pyothorax and empyema, pneumonia, urinary tract infection, intra-abdominal abscess, soft tissue infection, septic arthritis and osteomyelitis, and surgical-site infection. Ultrasound was useful for evaluating the extent and location of inflammation and abscess and for decision-making concerning surgical intervention. CONCLUSION Knowledge of these sonographic findings is important for sonographers during examinations and for physicians when determining the treatment plan and period of antibiotic therapy for infected lesions.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777, Japan.
| | - Yutaka Tanami
- Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777 Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777 Japan
| | - Kuntaro Deguchi
- Department of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, Japan
| | - Haruka Takei
- Department of Infectious Diseases and Immunology, Saitama Children’s Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children’s Medical Center, 1-2 Shintoshin Chuo-ku, Saitama, 330-8777 Japan
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Morita K, Takanarita Y, Matsushima S, Hatakeyama T. Partial median sternotomy approach for the repair of esophageal atresia. Pediatr Int 2023; 65:e15601. [PMID: 37674295 DOI: 10.1111/ped.15601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Keiichi Morita
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Yuki Takanarita
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
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29
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Risk Factors of Descending Necrotizing Mediastinitis in Deep Neck Abscesses. Medicina (B Aires) 2022; 58:medicina58121758. [PMID: 36556959 PMCID: PMC9788205 DOI: 10.3390/medicina58121758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives: Cervical space infection could also extend to the mediastinum due to the anatomical vicinity. The mortality rate of descending necrotizing mediastinitis is 85% if untreated. The aim of this study was to identify risk factors for the progression of deep neck abscesses to descending necrotizing mediastinitis. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing surgical treatment of deep neck abscesses from August 2017 to July 2022. Computed tomography (CT) was performed in all patients. Before surgery, lab data including hemoglobulin (Hb), white blood cell count, neutrophil percentage, C-reactive protein (CRP) level, and blood glucose were recorded. Patients' characteristics including gender, age, etiology, and presenting symptoms were collected. Hospitalization duration and bacterial cultures from the wound were also analyzed. Results: The C-reactive protein (CRP) level was higher in patients with a mediastinal abscess than in patients without a mediastinal abscess (340.9 ± 33.0 mg/L vs. 190.1 ± 72.7 mg/L) (p = 0.000). The submandibular space was more commonly affected in patients without a mediastinal abscess (p = 0.048). The retropharyngeal (p = 0.003) and anterior visceral (p = 0.006) spaces were more commonly affected in patients with a mediastinal abscess. Conclusions: Descending necrtotizing mediastinitis results in mortality and longer hospitalization times. Early detection of a mediastinal abscess on CT is crucial for treatment. Excluding abscesses of the anterior superior mediastinum for which transcervical drainage is sufficient, other mediastinal abscesses require multimodal treatment including ENT and thoracic surgery to achieve a good outcome.
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Zukowska A, Zukowski M. Surgical Site Infection in Cardiac Surgery. J Clin Med 2022; 11:jcm11236991. [PMID: 36498567 PMCID: PMC9738257 DOI: 10.3390/jcm11236991] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy.
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Affiliation(s)
- Agnieszka Zukowska
- Department of Infection Control, Regional Hospital Stargard, 73-110 Stargard, Poland
| | - Maciej Zukowski
- Department of Anesthesiology, Intensive Care and Acute Intoxication, Pomeranian Medical University, 70-204 Szczecin, Poland
- Correspondence: ; Tel.: +48-504-451-924
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Sugawara M, Takatsugu K, Kondo Y, Watanabe M, Matsumiya G, Kobayashi Y. Subcutaneous implantable cardioverter-defibrillator implantation in a patient with an axillary bifemoral bypass and past sternectomy. HeartRhythm Case Rep 2022; 9:80-83. [PMID: 36860744 PMCID: PMC9968905 DOI: 10.1016/j.hrcr.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masafumi Sugawara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan,Address reprint requests and correspondence: Dr Masafumi Sugawara, Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Kajiyama Takatsugu
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Using Closed Incision Negative Pressure Therapy Specialty Dressings over Incisions following Sternal Dehiscence Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4623. [DOI: 10.1097/gox.0000000000004623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022]
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Hwang NC, Sivathasan C. Preoperative Evaluation and Care of Heart Transplant Candidates. J Cardiothorac Vasc Anesth 2022; 36:4161-4172. [PMID: 36028377 DOI: 10.1053/j.jvca.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 11/11/2022]
Abstract
Heart transplantation is recommended for patients with advanced heart failure refractory to medical and device therapy, and who do not have absolute contraindications. When patients become eligible for heart transplantation, they undergo comprehensive evaluation and preparation to optimize their posttransplantation outcomes. This review provides an overview of the processes that are employed to enable the candidates to be transplant-ready when donor hearts are available.
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Affiliation(s)
- Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
| | - Cumaraswamy Sivathasan
- Mechanical Cardiac Support and Heart Transplant Program, Department of Cardiothoracic Surgery, National Heart Centre, Singapore
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Silverborn M, Heitmann LA, Sveinsdottir N, Rögnvaldsson S, Kristjansson TT, Gudbjartsson T. Non-infectious sternal dehiscence after coronary artery bypass surgery. J Cardiothorac Surg 2022; 17:249. [PMID: 36192764 PMCID: PMC9528060 DOI: 10.1186/s13019-022-02015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/24/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Non-infectious sternal dehiscence (NISD) is a known complication following coronary artery bypass grafting (CABG), with previous studies estimating an incidence of 0.4–1% of surgeries. We aimed to study the incidence of NISD together with short- and long-term outcomes in a whole-nation cohort of patients.
Materials and methods A retrospective study on consecutive CABG patients diagnosed with NISD at Landspitali from 2001 to 2020. Patients diagnosed with infectious mediastinitis (n = 20) were excluded. NISD patients were compared to patients with an intact sternum regarding patient demographics, cardiovascular risk factors, intra- and postoperative data, and estimated overall survival. The median follow-up was 9.5 years. Results Twenty out of 2280 eligible patients (0.88%) developed NISD, and the incidence did not change over the study period (p = 0.98). The median time of diagnosis was 12 days postoperatively (range, 4–240). All patients were re-operated using a Robicsek-rewiring technique, with two cases requiring a titanium plate for fixation. Patients with NISD were older, had a higher BMI and EuroSCORE II, lower LVEF, and more often had a history of COPD, MI, and diabetes compared to those without NISD. Length of stay was extended by 15 days for NISD patients, but short and long-term survival was not statistically different between the groups. Conclusions The incidence of NISD was low and in line with previous studies. Although the length of hospital stay was extended, both short- and long-term survival of NISD patients was not significantly different from patients with an intact sternum.
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Affiliation(s)
- Martin Silverborn
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland. .,Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Leon Arnar Heitmann
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Nanna Sveinsdottir
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Sigurjon Rögnvaldsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland
| | | | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Kiaii B, Johnston SS, Jang SR, Elangovanraaj N, Tewari P, Chen BPH. Clinical and economic outcomes after sternotomy for cardiac surgery with skin closure through 2-octyl cyanoacrylate plus polymer mesh tape versus absorbable sutures plus waterproof wound dressings: a retrospective cohort study. J Cardiothorac Surg 2022; 17:212. [PMID: 36031599 PMCID: PMC9420285 DOI: 10.1186/s13019-022-01956-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To compare clinical and economic outcomes after sternotomy for cardiac surgery with skin closure through 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT) versus conventional absorbable sutures plus waterproof wound dressings (CSWWD).
Methods
Retrospective study using the Premier Healthcare Database. Patients undergoing a cardiac surgery requiring sternotomy with 2OPMT or CSWWD were included. Primary outcome was 60-day cumulative incidence of diagnosis for wound complications (infection, dehiscence). Secondary outcomes were index admission hospital length of stay (LOS), total hospital-borne costs, discharge status, and 60-day cumulative incidences of inpatient readmission and reoperation. After propensity score matching, outcomes were compared between the 2OPMT and CSWWD groups using bivariate multilevel mixed-effects generalized linear models.
Results
Overall, 7,901 2OPMT patients and 10,775 CSWWD patients were eligible for study. After propensity score matching on 68 variables, each group comprised 5,338 patients (total study N = 10,676). The 2OPMT and CSWWD groups did not differ significantly in terms of the 60-day cumulative incidences of wound complication (3.47% vs 3.47%, p = 0.996), inpatient readmission (12.6% vs. 13.6%, p = 0.354), and reoperation (10.3% vs 10.1%, p = 0.808), as well as discharge to home versus non-home setting (77.2% vs. 75.1%), p = 0.254. However, the 2OPMT group had significantly lower LOS (9.2 days vs 10.6 days, p < 0.001) and total hospital-borne costs ($50,174 vs $60,526, p < 0.001).
Conclusions
This large observational study provides evidence that sternotomy skin closure with 2OPMT is associated with nearly identical 60-day cumulative incidence of wound complication as compared with CSWWD, while exhibiting a significant association with lower LOS and total hospital-borne costs.
Trial registration Not applicable.
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Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience. Antibiotics (Basel) 2022; 11:antibiotics11050664. [PMID: 35625308 PMCID: PMC9137525 DOI: 10.3390/antibiotics11050664] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/03/2022] Open
Abstract
Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo’s classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.
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Ten Dam L, Ten Broeke M, Poot AM, Gilbers MD, Halfwerk FR. Noninfectious sternal wound inflammation after coronary artery bypass grafting in a patient with myelodysplastic syndrome: A no-touch approach. J Card Surg 2022; 37:2419-2422. [PMID: 35524433 PMCID: PMC9321867 DOI: 10.1111/jocs.16570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/06/2022] [Accepted: 04/17/2022] [Indexed: 11/28/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare, chronic inflammatory noninfectious dermatosis. It is associated with underlying systemic or hematological diseases such as myelodysplastic syndrome (MDS) and can be triggered after surgery. Recognition and diagnosis of PG can be difficult as it can mimic a wound infection. Misdiagnosis could lead to invasive procedures which worsen the disease and have possible disastrous aftermath. A 74‐year‐old male with a history of MDS presents with an atypical sternal wound inflammation. Diagnosis confirmed PG after skin biopsy. No surgical or invasive procedures were performed and the patient was treated on an outpatient basis with prednisolone, clobetasol cream, and cyclosporine. This case shows the importance of a rapid diagnosis of the disease. Awareness is required for the diagnosis of PG in a wound with pronounced livid borders, without improvement after antibiotic treatment or worsening after debridement. Rapid diagnosis and treatment reduce high healthcare costs, morbidity, and mortality.
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Affiliation(s)
- Lotte Ten Dam
- Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Miarca Ten Broeke
- Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Angelique M Poot
- Department of Dermatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Martijn D Gilbers
- Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Frank R Halfwerk
- Department of Cardio-Thoracic Surgery, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands
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Yu CM, Yu CM, Yao WT, Chen YF, Lee AL, Liu YC, Tu CP, Huang WC, Tung KY, Tsai MF. Efficacy and safety of pectoralis muscle flap combined rectus abdominis muscle sheath fasciocutaneous flap for reconstruction of sternal infection. Int Wound J 2022; 19:1829-1837. [PMID: 35289489 PMCID: PMC9615267 DOI: 10.1111/iwj.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Few studies have assessed the efficacy and safety of reconstruction of sternal infection using a pectoralis muscle flap combined with a rectus abdominis muscle (RAM) sheath fasciocutaneous flap. We report here our experience with this procedure to reconstruct the sternal defect in patients (n = 46) with a deep sternal wound infection (DSWI) after cardiac surgery. After wound reconstruction, the proportion of prolonged mechanical ventilation use and intensive care unit (ICU) stay were 17.4% (n = 8) and 21.7% (n = 10), respectively. The 30‐day all‐cause mortality was 15.2%; recurrence rate was 17.4%; postoperative complications were 15.2%; and median hospital stay was 31 (0‐157) days. Multivariate logistic regression analysis revealed that hypertension (β = 21.32, 95%CI 4.955‐37.68, P = .014), drainage‐tube use (β = 0.944, 95%CI 0.273‐1.614, P = .008), and prolonged intensive care unit stay (β = 53.65, 95%CI 31.353‐75.938, P < .001) were significantly correlated with hospital stay. In conclusion, a procedure including surgical debridement, sternal reconstruction with bilateral PM and RAM sheath flap, long‐term antibiotics, and adequate drainage is a beneficial technique in the reconstruction of deep sternal wound infection after cardiac surgery. Duration of drainage tube use may be as an index for a hospital stay or wound healing.
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Affiliation(s)
- Chieh-Ming Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Chia-Meng Yu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Wen-Teng Yao
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Yu-Fan Chen
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - An-Li Lee
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Ying-Chun Liu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Chih-Peng Tu
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Wen-Chen Huang
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Kwang-Yi Tung
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Burn Center, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Ming-Feng Tsai
- Division of Plastic Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, Collage of Medical Science and Technology, Taipei Medical University, Taipei City, Taiwan
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Vodička J, Geiger J, Židková A, Andrle P, Mírka H, Svatonˇ M, Kostlivý T. Acute Mediastinitis - Outcomes and Prognostic Factors of Surgical Therapy (A Single-Center Experience). Ann Thorac Cardiovasc Surg 2022; 28:171-179. [PMID: 35264480 PMCID: PMC9209895 DOI: 10.5761/atcs.oa.21-00147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy. Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment. Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times. Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.
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Affiliation(s)
- Josef Vodička
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Jan Geiger
- Department of Surgery, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Alexandra Židková
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavel Andrle
- Department of Stomatology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Svatonˇ
- Department of Pneumology and Phthisiology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Tomáš Kostlivý
- Department of Otorhinolaryngology, Faculty of Medicine in Pilsen, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
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Bae SJ, Kim I, Song J, Chung ES. The effect of first- and third-generation prophylactic antibiotics on hospitalization and medical expenditures for cardiac surgery. J Cardiothorac Surg 2022; 17:15. [PMID: 35120545 PMCID: PMC8817574 DOI: 10.1186/s13019-022-01763-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitalizations, and medical costs. METHODS All adult patients (≥ 20 years) undergoing cardiac surgery at one hospital from January 01, 2009, to December 31, 2016, were included in this study. A single prophylactic antibiotic was administered at a dose of 1 g within one hour of the surgical incision and for three days after surgery at eight-hour intervals. After propensity score matching, 194 patients in each antibiotic prophylaxis group (first-generation vs third-generation) were analyzed. Among the 388 patients, the incidence of surgical site infections was compared according to the type of prophylactic antibiotic, and risk factors were evaluated by chi-squared tests followed by multivariate logistic regression analysis. RESULTS The incidence of deep surgical site infections was significantly lower in the first-generation group (5.7%) than in the third-generation group (16.5%). The pathogens isolated from the surgical infection sites were similarly distributed in both groups. However, the prevalence of highly infectious gram-positive bacteria was more than that of gram-negative bacteria (67% vs 23%). The preoperative hospitalization duration, mean operation time, and ventilator use time were similar in both groups, but the postoperative hospitalization duration was significantly shorter in the first-generation group (25.5 days) than in the third-generation group (29.8 days). In addition, the medical costs were lower in the first-generation group (20,594 USD) than in the third-generation group (26,488 USD). CONCLUSION In conclusion, the first-generation prophylactic antibiotic was better than the third-generation in reducing surgical site infection rates, hospitalization length, and medical expenditures.
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Affiliation(s)
- Sung-Jin Bae
- Department of Health Science, Hanyang University Graduate School, Seoul, Korea.,Department of Cardiovascular Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Inah Kim
- Department of Health Science, Hanyang University Graduate School, Seoul, Korea. .,Department of Occupational and Environment Medicine, Hanyang University College of Medicine, Seoul, Korea.
| | - Jaechul Song
- Department of Health Science, Hanyang University Graduate School, Seoul, Korea.,Department of Occupational and Environment Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Euy-Suk Chung
- Department of Cardiovascular Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Iatrogenic Tracheal Rupture Related to Prehospital Emergency Intubation in Adults: A 15-Year Single Center Experience. Prehosp Disaster Med 2022; 37:57-64. [PMID: 35012697 DOI: 10.1017/s1049023x21001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Iatrogenic tracheal rupture is an unusual and severe complication that can be caused by tracheal intubation. The frequency, management, and outcome of iatrogenic tracheal rupture due to prehospital emergency intubation in adults by emergency response physicians has not yet been sufficiently explored. METHODS Adult patients with iatrogenic tracheal ruptures due to prehospital emergency intubation admitted to an academic referral center over a 15-year period (2004-2018) with consideration of individual risk factors were analyzed. RESULTS Thirteen patients (eight female) with a mean age of 67 years met the inclusion criteria and were analyzed. Of these, eight tracheal ruptures (62%) were caused during the airway management of cardiopulmonary resuscitation (CPR). Stylet use and difficult laryngoscopy requiring multiple attempts were documented in eight cases (62%) and four cases (30%), respectively. Seven patients (54%) underwent surgery, while six patients (46%) were treated conservatively. The overall 30-day mortality was 46%; five patients died due to their underlying emergencies and one patient died of tracheal rupture. Three survivors (23%) recovered with severe neurological sequelae and four (30%) were discharged in good neurological condition. Survivors had significantly smaller mean rupture sizes (2.7cm versus 6.3cm; P <.001) and less cutaneous emphysema (n = 2 versus n = 6; P = .021) than nonsurvivors. CONCLUSIONS Iatrogenic tracheal rupture due to prehospital emergency intubation is a rare complication. Published risk factors are not consistently present and may not be applicable to identify patients at high risk, especially not in rescue situations. Treatment options depend on individual patient condition, whereas outcome largely depends on the underlying disease and rupture extension.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:531-532. [DOI: 10.1093/ejcts/ezac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/24/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE OF REVIEW Poststernotomy mediastinitis (PSM) remains a serious infection and is significantly associated with high morbidity, short-term and long-term mortality. Gram-negative bacteria (GNB) are an underestimated cause of PSM, and there is little information on the risk factors, prevention, diagnosis and management of GNB PSM. RECENT FINDINGS The pathogenesis of PSM is the result of a complex and multifactorial interplay between intraoperative wound contamination, host-related and surgical host factors but GNB are probably mostly translocated from other host site infections. GNB are frequent cause of PSM (18-38% of cases) and GNB PSM have shown to more frequently polymicrobial (20-44%). GNG PSM has shown to occur earlier than Gram-positive PSM. Early diagnosis is crucial to successful treatment. The management of PSM needs a combination of culture-directed antimicrobial therapy and an early extensive surgical debridement with either immediate or delayed closure of the sternal space. Antibiotic treatment choice and duration should be based on clinical evaluation, evolution of inflammatory markers, microbiological tests and imaging studies. Mortality has shown to be significantly higher with GNB PSM compared with other causes and the inappropriateness of initial antibiotic therapy may explain the worse outcome of GNB PSM. SUMMARY GNB PSM is usually undervalued in the setting of PSM and have shown to be a frequent cause of inappropriate treatment with adverse prognostic potential. There is a need for efforts to improve knowledge to prevent and adequately treat GNB PSM.
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44
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Takami Y, Amano K, Sakurai Y, Akita K, Hayashi R, Maekawa A, Takagi Y. Impact of preoperative nasopharyngeal cultures on surgical site infection after open heart surgery. JTCVS OPEN 2021; 8:478-486. [PMID: 36004050 PMCID: PMC9390427 DOI: 10.1016/j.xjon.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Objectives Despite advances in surgical techniques and management, surgical site infection (SSI) is still important after cardiovascular surgery. We investigated to determine whether or not preoperative nasopharyngeal cultures (NCx) can predict SSI and its microbial spectrum. Methods A retrospective review was done in 1226 consecutive patients undergoing NCx and cardiac and thoracic aortic surgery via median sternotomy who were cared for with the standard SSI bundle between 2013 and 2018. Microorganisms isolated from the NCx and SSI pathogens were counted to explore the microbial pattern and associated variables in patients with and without postoperative SSI. Perioperative management was not changed by collection of preoperative NCx. Results There were 1281 and 127 microorganisms, including coagulase-negative Staphylococcus as the most prevalent, isolated from 784 nasal and 111 pharyngeal specimens, respectively. Postoperative SSI occurred in 31 patients (2.47%), including chest, groin, and leg SSI. Significant coincidence of the SSI pathogens with the NCx microorganisms was not observed. However, the patients with SSI showed significantly higher positive rates of preoperative NCx than those without SSI. The sensitivity/specificity of NCx for SSI were 81%/37% for nasal and 45%/92% for pharyngeal, respectively. The negative predictive value of NCx for ruling out SSI was 98.6% for nasal and 98.4% for pharyngeal, respectively. Independent risk factors for postoperative SSI included female sex, diabetes mellitus, positive preoperative NCx, and postoperative use of Portex Mini-Trach (Smiths Medical, Minneapolis, Minn) or tracheostomy on multivariate analysis. Conclusions Preoperative NCx may be useful to predict SSI after open heart surgery via median sternotomy, as well as screening for methicillin-resistant Staphylococcus aureus.
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45
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Sánchez-Matás C, Aldabó-Pallas T, Palacios-García I, Jiménez-Sánchez M. Ascending necrotizing mediastinitis. An exceptional case. Arch Bronconeumol 2021; 57:780-782. [PMID: 35698993 DOI: 10.1016/j.arbr.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/03/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Carmen Sánchez-Matás
- Servicio de Cirugía Torácica, UGC de Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Teresa Aldabó-Pallas
- UGC de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Vos RJ, van Putte BP, de Mol BAJM, Hoogewerf M, Mandigers TJ, Kloppenburg GTL. Application of local gentamicin in the treatment of deep sternal wound infection: a randomized controlled trial. Eur J Cardiothorac Surg 2021; 61:1135-1141. [PMID: 34849690 DOI: 10.1093/ejcts/ezab479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES In patients with deep sternal wound infection (DSWI), primary closure of the sternal bone over high negative pressure Redon drains has shown to be a safe and feasible treatment method. Addition of local gentamicin could accelerate healing and improve clinical outcomes. METHODS We conducted a randomized controlled trial to evaluate the effectiveness of local gentamicin in the treatment of DSWI. In the treatment group, collagenous carriers containing gentamicin were left between the sternal halves during sternal refixation. In the control group, no local antibiotics were used. Primary outcome was hospital stay. Secondary outcomes were mortality, reoperation, wound sterilization time, time till removal of all drains and duration of intravenous antibiotic treatment. RESULTS Forty-one patients were included in the trial of which 20 were allocated to the treatment group. Baseline characteristics were similar in both groups. Drains could be removed after a median of 8.5 days in the treatment group and 14.5 days in the control group (P-value: 0.343). Intravenous antibiotics were administered for a median of 23.5 days in the treatment group and 38.5 days in the control group (P-value: 0.343). The median hospital stay was 27 days in the treatment group and 28 days in the control group (P-value: 0.873). Mortality rate was 10% in the treatment group and 9.5% in the control group (P-value: 0,959). No side effects were observed. CONCLUSIONS This randomized controlled trial showed that addition of local gentamicin in the treatment of DSWI did not result in shorter length of stay. CLINICAL TRIAL REGISTRATION NUMBER 2014-001170-33.
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Affiliation(s)
- Roemer J Vos
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Bas A J M de Mol
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marieke Hoogewerf
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Tim J Mandigers
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
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47
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Mantzouranis K, Georgakopoulou VE, Mermigkis D, Damaskos C, Garmpis N, Papalexis P, Gkoufa A, Drossos P, Chlapoutakis S, Garmpi A, Sklapani P, Trakas N, Tsiafaki X. Staphylococcus aureus mediastinitis following a skin infection in a non-immunocompromised patient: A case report. Biomed Rep 2021; 15:104. [PMID: 34760277 PMCID: PMC8567464 DOI: 10.3892/br.2021.1480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/12/2021] [Indexed: 11/06/2022] Open
Abstract
Mediastinitis is a severe inflammation of the structures located in the mid-chest cavity. Three main causes of infective mediastinitis are traditionally recognized: Deep infection of a sternal wound following cardiothoracic surgery, perforation of the esophagus, and the descending necrotizing mediastinitis as a result of odontogenic, pharyngeal or cervical infections. Mediastinitis, as a complication of skin infection with hematogenous spread is infrequent. Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacteria, and is responsible for numerous severe infections. MRSA mediastinitis is a rare infection and is typically associated with complications of sternotomy and retropharyngeal abscesses. Here, the second known case of mediastinitis of a hematogenous origin in a non-immunocompromised 41-year-old patient following primary skin infection, accompanied by sternal osteomyelitis, lung consolidation and pleural effusion is described; MRSA was the responsible pathogen. The clinical course was favorable after 6 weeks of antibiotics administration without drainage or surgical intervention.
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Affiliation(s)
| | | | | | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research; Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research; Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.,Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Aikaterini Gkoufa
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Drossos
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | | | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pagona Sklapani
- Department of Cytology, Mitera Hospital, 15123 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Xanthi Tsiafaki
- 1st Pulmonology Department Sismanogleio Hospital, 15126 Athens, Greece
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48
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Kitano D, Matsuo J, Sakakibara S, Oomura A, Osaki T, Okada K, Terashi H. Extra-Anatomical Bypass Grafting and Latissimus Dorsi Myocutaneous Flap Reconstruction for Post-sternotomy Mediastinitis With Prosthetic Aortic Graft Infection. Cureus 2021; 13:e18086. [PMID: 34692301 PMCID: PMC8523244 DOI: 10.7759/cureus.18086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Extra-anatomical bypass grafting is a surgical method used to remove an infected aortic graft and promote revascularization with a new graft in the non-infected area. Here, we report a case of intractable post-sternotomy mediastinitis (PSM) with aortic graft infection which was treated with extra-anatomical bypass grafting. A 56-year-old woman with a history of multiple aortic dissection and prosthetic graft replacement in the thoracoabdominal area developed PSM with aortic arch graft infection. Bacterial culture of the exposed prosthetic graft tissue yielded multidrug-resistant Pseudomonas aeruginosa. Meticulous debridement of the wound and management by negative pressure wound therapy with continuous irrigation was performed. However, the infection of the prosthetic graft could not be controlled. Extra-anatomical bypass was performed between the left common carotid artery and right subclavian artery via the right common carotid artery. Then, the infected graft was removed. After the resolution of infection, the mediastinal wound was reconstructed with a pedicled latissimus dorsi myocutaneous flap, which was harvested from the right dorsum. No recurrence of infection occurred in the nine-month follow-up period. Debridement and removal of exposed artificial graft are considered the gold standard for treating wound infection. In situ replacement of infected aortic grafts carries a risk of re-infection due to residual bacterial contamination of the periprosthetic tissue. Extra-anatomical bypass would be a useful option for reducing the risk of re-infection in patients with intractable PSM and prosthetic aortic graft infection. Further studies are warranted to evaluate the risks and benefits of this operative method.
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Affiliation(s)
| | - Jiro Matsuo
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Atsushi Oomura
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Takeo Osaki
- Plastic Surgery, Hyogo Cancer Center, Akashi, JPN
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
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Moyon Q, Lebreton G, Huang F, Demondion P, Desnos C, Chommeloux J, Hékimian G, Bréchot N, Nieszkowska A, Schmidt M, Leprince P, Combes A, Luyt CE, Pineton de Chambrun M. Characteristics and outcomes of patients with postoperative Candida versus bacterial mediastinitis: a case-matched comparative study. Eur J Cardiothorac Surg 2021; 61:523-530. [PMID: 34662391 DOI: 10.1093/ejcts/ezab437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Postoperative mediastinitis, a feared complication after cardiac surgery, is associated with high mortality, especially of critically ill patients. Candida species infections are rare and severe, with poorly known outcomes. We conducted a case-control study to describe the characteristics, management and outcomes of patients with postoperative Candida mediastinitis. METHODS This French, monocentre, retrospective study included all patients with postoperative Candida mediastinitis (January 2003-February 2020) requiring intensive care unit admission. Candida mediastinitis patients (henceforth cases) were matched 1:1 with postoperative bacterial mediastinitis (henceforth control), based on 3 factors during mediastinitis management: age >40 years, cardiac transplantation and invasive circulatory device used. The primary end point was the probability of survival within 1 year after intensive care unit (ICU) admission. RESULTS Forty cases were matched to 40 controls. The global male/female ratio was 2.1, with mean age at admission 47.9 ± 13.8 years. Candida species were: 67.5% albicans, 17.5% glabrata, 15% parapsilosis, 5.0% tropicalis, 2.5% krusei and 2.5% lusitaniae. The median duration of mechanical ventilation was 23, 68.8% of patients received renal replacement therapy and 62.5% extracorporeal membrane oxygenation support. The probability of survival within the first year after ICU admission was 40 ± 5.5% and was significantly lower for cases than for controls (43 ± 8% vs 80 ± 6.3%, respectively; Log-rank test: P < 0.0001). The multivariable Cox proportional hazards model retained only renal replacement therapy [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.1-13.1; P = 0.04] and Candida mediastinitis (HR 2.4, 95% CI 1.1-5.6; P = 0.04) as independently associated with 1-year mortality. CONCLUSIONS Candida mediastinitis is a serious event after cardiac surgery and independently associated with 1-year mortality. Further studies are needed to determine whether deaths are directly attributable to Candida mediastinitis.
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Affiliation(s)
- Quentin Moyon
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Service de Médecine Interne, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France
| | - Guillaume Lebreton
- Service de Chirurgie Cardiothoracique, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Florent Huang
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Pierre Demondion
- Service de Chirurgie Cardiothoracique, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Cyrielle Desnos
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Juliette Chommeloux
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Guillaume Hékimian
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Nicolas Bréchot
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Ania Nieszkowska
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Pascal Leprince
- Service de Chirurgie Cardiothoracique, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut de Cardiologie, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Paris, France.,Service de Médecine Interne, Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Paris, France.,Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
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50
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Commentary: Mediastinitis postcoronary artery bypass grafting: From awfully simple to simply awful. J Thorac Cardiovasc Surg 2021; 162:1131-1132. [DOI: 10.1016/j.jtcvs.2020.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/23/2022]
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