Mediastinitis due to Gram-negative bacteria is associated with increased mortality

Authors

  • H. Charbonneau,

    Corresponding author
    1. Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
    2. Université Paris-Descartes, Faculté de Médecine, Paris, France
    • Corresponding author: H. Charbonneau, Hôpital Européen Georges Pompidou, Intensive care unit, 15-20 rue Leblanc, Paris 75015, France

      E-mail: helenecharbs@hotmail.com

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  • J. M. Maillet,

    1. Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
    2. Department of intensive care, Hôpital Centre Cardiologique du Nord, Saint Denis, France
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  • M. Faron,

    1. Epidemiology and Clinical Research Unit, Institute of cancerology Gustave Roussy, Villejuif, France
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  • O. Mangin,

    1. Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
    2. Université Paris-Descartes, Faculté de Médecine, Paris, France
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  • E. Puymirat,

    1. Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
    2. Université Paris-Descartes, Faculté de Médecine, Paris, France
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  • P. Le Besnerais,

    1. Department of intensive care, Hôpital Centre Cardiologique du Nord, Saint Denis, France
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  • L. Du Puy-Montbrun,

    1. Université Paris-Descartes, Faculté de Médecine, Paris, France
    2. Department of cardiovascular surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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  • P. Achouh,

    1. Université Paris-Descartes, Faculté de Médecine, Paris, France
    2. Department of cardiovascular surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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  • J. L. Diehl,

    1. Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
    2. Université Paris-Descartes, Faculté de Médecine, Paris, France
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  • J.-Y. Fagon,

    1. Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
    2. Université Paris-Descartes, Faculté de Médecine, Paris, France
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  • J.-l. Mainardi,

    1. Université Paris-Descartes, Faculté de Médecine, Paris, France
    2. Department of Microbiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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  • E. Guerot

    1. Department of intensive care, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
    2. Université Paris-Descartes, Faculté de Médecine, Paris, France
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Abstract

The aim of this study was to describe the features of a large cohort of patients with postoperative mediastinitis, with particular regard to Gram-negative bacteria (GNB), and assess their outcome. This bicentric retrospective cohort included all patients who were hospitalized in the Intensive Care Unit with mediastinitis after cardiac surgery during a 9-year period. Three hundred and nine patients developed a mediastinitis with a mean age of 65 years and a mean standard Euroscore of six points. Ninety-one patients (29.4%) developed a GNB mediastinitis (GNBm). Of the 364 pathogens involved, 103 GNB were identified. GNBm were more frequently polymicrobial (44% versus 3.2%; p <0.001). Being female was the sole independent risk factor of GNBm in multivariate analysis. Initial antimicrobial therapy was significantly more frequently inappropriate with GNBm compared with other microorganisms (24.6% versus 1.9%; p <0.001). Independent risk factors for inappropriateness of initial antimicrobial treatment were GNBm (OR = 8.58, 95%CI 2.53–29.02, p 0.0006), and polymicrobial mediastinitis (OR = 4.52, 95%CI 1.68–12.12, p 0.0028). GNBm were associated with more drainage failure, secondary infection, need for prolonged mechanical ventilation and/or use of vasopressors. Thirty-day hospital mortality was significantly higher with GNBm (31.9 % versus 17.0%; p 0.004). GNBm was identified as an independent risk factor of hospital mortality (OR = 2.31, 95%CI 1.16–4.61, p 0.0179).

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