Impact of infectious diseases consultation and oral sequential therapy in the management of post-surgical mediastinitis

Abstract

Introduction: Post-cardiac surgery mediastinitis (PSM) is a serious, complex, and multifactorial complication of surgical procedures. Infectious diseases consultation (IDC) has demonstrated improvement in other complex infectious diseases. The objective of the study was to evaluate the impact of IDC in the management and outcome of patients with PSM.

Methods: Observational retrospective study, of adult patients with PSM between January 2010 and June 2021. After January 2016, IDC was performed in all the patients with PSM. The primary endpoint was clinical success, a composite variable of clinical cure, and absence of adverse events, or recurrence. Also, in-hospital stay, and clinical cure was evaluated in patients that received oral sequential therapy (OST).

Results: A total of 84 patients with PSM were included, 48 pre-IDC and 36 in IDC period. No differences in clinical success were observed between the two periods (pre-IDC 60% vs, IDC 77%, p=0.104). During the IDC period the rate of adequate targeted antibiotic treatment was higher (pre-IDC 71% vs. IDC 94%, p=0.016). Gram-negative bacilli infections (pre-IDC 42% vs. IDC 78%, p=0.002) and polymicrobial infections (pre-IDC 37% vs. IDC 63%, p=0.004) increased in the IDC period. Multivariate analysis did not show any variable associated with clinical success. OST was similar in both periods, and a shorter in-hospital stay was observed in the patients who underwent OST (no-OST, 70 days vs. OST, 44 days, p=0.003).

Conclusions: IDC was related with a higher adequate targeted antimicrobial therapy. We observed that OST offers a promising strategy in the management of this infection.

Keywords: Clinical success; Consulta de enfermedades infecciosas; Infección quirúrgica; Infectious diseases consultation; Mediastinitis posquirúrgica; Nosocomial; Oral sequential therapy; Post-surgical mediastinitis; Surgical infection; Terapia secuencial oral; Éxito clínico.