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. 2024 May 3;11(5):ofae225.
doi: 10.1093/ofid/ofae225. eCollection 2024 May.

Infectious Mediastinitis: A Retrospective Cohort Study

Thomas Lemmet  1 , Jean-Philippe Mazzucotelli  2 , Olivier Collange  3 , Léa Fath  4 , Didier Mutter  5 , Cécile Brigand  6 , Pierre-Emmanuel Falcoz  7 , François Danion  1 , Nicolas Lefebvre  1 , Morgane Bourne-Watrin  1 , Victor Gerber  1 , Baptiste Hoellinger  1 , Thibaut Fabacher  8 , Yves Hansmann  1 , Yvon Ruch  1
Affiliations

Infectious Mediastinitis: A Retrospective Cohort Study

Thomas Lemmet et al. Open Forum Infect Dis. .

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.

Keywords: descending necrotizing mediastinitis; esophageal perforation; infectious mediastinitis; sternotomy.

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Conflict of interest statement

Potential conflicts of interest. F. D. declares personal fees from Gilead, Pfizer, and MSD, outside the submitted work. V. G. declares honoraria from Pfizer, outside the submitted work. Y. H. declares receiving support for attending meetings and/or travel from Pfizer, outside the submitted work. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Study flow chart. Abbreviations: DNM, descending necrotizing mediastinitis; MEP, mediastinitis due to esophageal perforation; PMSI, Program of Medicalization of Information Systems; PSM, poststernotomy mediastinitis. Other mediastinitis included broncho-mediastinal fistulas (2/11), necrotic pulmonary infarction complicated with mediastinitis (1/11), mediastinitis in a heart transplant patient (1/11), infection of a mediastinal hematoma of undetermined origin (1/11), mediastinitis due to a perforation by port-a-cath (1/11) and by an extracorporeal circulatory assistance device (1/11), and mediastinitis of unknown origin (4/11).
Figure 2.
Figure 2.
Survival curves: all-cause mortality at one-year follow-up. Abbreviations: DNM, descending necrotizing mediastinitis; MEP, mediastinitis due to esophageal perforation; PSM, poststernotomy mediastinitis. A: All mediastinitis. B: For the main aetiologies: PSM, mediastinitis associated with oesophageal perforation (MOP), DNM.
See this image and copyright information in PMC

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