title: Is it possible to cure mediastinitis in patients with major postcardiac surgery complications?
abstract: BACKGROUND
  The prognosis for mediastinitis after cardiac operation has improved during the last two decades, but most series do not include patients who already have a major postoperative complication when the infection developed.
  
  
  METHODS
  Our 9-year prospective study of 371 consecutive patients with mediastinitis compared the characteristics of patients admitted to the intensive care unit primarily for mediastinitis with those who developed mediastinitis after intensive care unit admission for severe postoperative organ failure.
  
  
  RESULTS
  We identified 323 (87%) primary and 48 (13%) secondary mediastinitis patients. The incubation time for mediastinitis was longer for secondary mediastinitis patients, despite similar initial operations. Staphylococcus aureus was responsible for approximately 60% of the episodes in both groups; however, the incidence of methicillin resistance was 2.5 times higher in secondary mediastinitis patients (p < 0.0001). The mediastinitis cure rate was similar for both groups. However, intensive care unit mortality (63% versus 21%), duration of mechanical ventilation (40 versus 9 days), and length of intensive care unit stay (53 versus 28 days) were significantly higher for secondary mediastinitis patients (p < 0.0001).
  
  
  CONCLUSIONS
  The presence of a prior major postoperative complication does not alter the cure rate of mediastinal infections, but does greatly reduce the survival rate.
authors.affiliation: Service de Reanimation Médicale, Hôpital Bichat, Paris, France. alain.combes@bch.ap-hop-paris.fr
authors.forename: A
authors.initials: A
authors.lastname: Combes
authors.forename: J L
authors.initials: JL
authors.lastname: Trouillet
authors.forename: J
authors.initials: J
authors.lastname: Baudot
authors.forename: M
authors.initials: M
authors.lastname: Mokhtari
authors.forename: J
authors.initials: J
authors.lastname: Chastre
authors.forename: C
authors.initials: C
authors.lastname: Gibert
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies