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Staphylococcus aureus Mediastinitis: Prognostic Usefulness of an Early Medicosurgical Therapy

Published online by Cambridge University Press:  02 January 2015

Pascal Voiriot ,
J. André Marcoux ,
Raymond Duperval  and
Javier Teijeira
Pascal Voiriot
Affiliation:
Division of Infectious Diseases, Department of Medicine, Québec, Canada Department of Cardiovascular Surgery, University of Sherbrooke School of Medicine, Sherbrooke, Québec, Canada
J. André Marcoux*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Québec, Canada Department of Cardiovascular Surgery, University of Sherbrooke School of Medicine, Sherbrooke, Québec, Canada
Raymond Duperval
Affiliation:
Division of Infectious Diseases, Department of Medicine, Québec, Canada Department of Cardiovascular Surgery, University of Sherbrooke School of Medicine, Sherbrooke, Québec, Canada
Javier Teijeira
Affiliation:
Division of Infectious Diseases, Department of Medicine, Québec, Canada Department of Cardiovascular Surgery, University of Sherbrooke School of Medicine, Sherbrooke, Québec, Canada
*
Division of Infectious Diseases, University of Sherbrooke School of Medicine, Sherbrooke, Québec, CanadaJIH 5N4
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Abstract

Six cases of acute Staphylococcus aureus mediastinitis after median sternotomy were reported. Five resulted from an asymptomatic disseminator of 5 aureus present in the operating room. Each case was characterized by an acute bacteremic phase, occurring after a mean interval of 8.2 ± 1.7 days after the surgical procedure; within 24 to 36 hours all patients had a temperature above 39°C, toxic appearance, and marked leukocytosis. Pericicatricial inflammation was moderate, instability of the sternum was present in only two patients, and chest roentgenogram was not helpful in making an early diagnosis. No risk factor for mediasinitis in connection with the perioperative or postoperative periods was noted in cases compared with a control group of 103 patients. All strains of S aureus were susceptible in vitro to the antibiotic regimen used in prophylaxis. All patients underwent early surgical reopening of the mediastinum within 47 ± 15 hours after the first sign of acute mediastinitis. Mediastinal debridement and continuous irrigation-suction with dilute povidone-iodine solution were associated with intravenous antistaphylococcal therapy for a period of four to six weeks. All patients survived and no recurrence was observed, a finding we think due to early diagnosis and aggressive medicosurgical therapy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 8 , Issue 8 , August 1987 , pp. 325 - 328
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1987

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