title: Postoperative mediastinitis in children: improvement of simple primary closed drainage.
abstract: BACKGROUND
  Mediastinitis is a significant cause of postoperative morbidity. In 1989, we proposed simple primary closed drainage as a new treatment. Our goal is to describe improvements made to the original technique.
  
  
  METHODS
  After wound debridement, infected areas were drained with Redon catheters connected to strong negative-pressure drainage bottles. Mediastinal effluents were cultured every day, and the catheters were withdrawn when the effluent culture was negative for microorganisms. Patients were classified into three groups: isolated mediastinitis (group 1), mediastinitis associated with endocarditis (group 2), and mediastinitis associated with other organ failure (group 3).
  
  
  RESULTS
  Sixty-four patients were treated during a 10-year period: 15 neonates, 33 infants, and 16 children. Group 1 consisted of 40 patients. The time to mediastinal sterilization was 4 days (range, 1 to 14 days), and the antibiotic course was 11 days (range, 7 to 28 days), with a hospital stay of 13 days (range, 10 to 30 days). No deaths occurred in this group. Group 2 consisted of 7 patients. The time to mediastinal sterilization was 8 days (range, 3 to 10 days), and the antibiotic course was 30 days (range, 26 to 37 days), with a hospital stay of 37 days (range, 20 to 54 days). One patient in group 2 did not survive. Group 3 consisted of 17 patients. The time to mediastinal sterilization was 6 days (range, 1 to 10 days), and the antibiotic course was 15 days (range, 10 to 31 days), with a hospital stay of 20 days (range, 18 to 36 days). Two patients in group 3 did not survive. None of the deaths was directly related to mediastinitis, as the mediastinum was sterile in all 3 patients before death.
  
  
  CONCLUSIONS
  This simple treatment was efficient and reliable in achieving mediastinal sterilization. In addition, short antibiotic courses decreased restraint, which is poorly tolerated in pediatric patients.
authors.affiliation: Intensive Care Unit of Pediatric Cardiac Surgery, Institut Jacques Cartier, Massy, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Anslot
authors.forename: Sylvie
authors.initials: S
authors.lastname: Hulin
authors.forename: Yves
authors.initials: Y
authors.lastname: Durandy
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D004322:Drainage / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D011183:Postoperative Complications / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents