Treatment of recurrent staphylococcal mediastinitis: still a controversial issue.
BACKGROUND
Although surgical management with early debridement and closed mediastinal irrigation has proved successful in reducing early mortality following poststernotomy deep sternal wound infection, recurrence rates are still up to 20%. This study compared the effectiveness and safety of wound dressing with granulated sugar versus early muscle flap surgery in the management of recurrent postoperative Staphylococcal mediastinitis.


METHODS
Between January 1995 and January 2002, 25 patients with severe recurrent staphylococcal mediastinitis were treated with granulated sugar wound dressing (group A) or with wound debridement, v-shape sternectomy and associated muscle flap surgery (group B). Clinical outcomes and perioperative data were analyzed. Outcomes were compared between the groups evaluating the length of time for normalization of white blood cell (WBC) count and of body temperature and length of hospital stay. Patient characteristics determining best treatment option were identified. Survival and incidence of recurrence at follow-up were also analyzed.


RESULTS
Study groups proved homogenous as to preoperative characteristics. Complete cure was achieved earlier in group A than in group B (defervescence: p = 0.0005; WBC normalization: p = 0.0001, respectively). Hospital stay was shorter in group A. A statistically significant difference was found in hospital mortality (16% overall) between the two groups with better outcomes in group A (p = 0.039). In the patient subset with the most severe preoperative profile (hemodialysis, tracheostomy, inotropic support) surgical treatment produced worse results than the sugar dressing method (p 0.048). No case of recurrence was observed.


CONCLUSIONS
Both treatments proved effective in recurrent type IV A Staphylococcal mediastinitis. Granulated sugar proved a safer option in severely compromised patients.
De Feo
Marisa
M
Department of Cardiothoracic and Respiratory Sciences, Second University of Naples and Department of Cardiovascular Surgery, V. Monaldi Hospital, Naples, Italy. marisa.defeo@tin.it
De Santo
Luca Salvatore
LS
Romano
Gianpaolo
G
Renzulli
Attilio
A
Della Corte
Alessandro
A
Utili
Riccardo
R
Cotrufo
Maurizio
M
D000368:Aged; D001458:Bandages; D002241:Carbohydrates / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D003646:Debridement; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008480:Mediastinitis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
D002241:Carbohydrates