title: Descending necrotizing mediastinitis: unique complication of central venous catheterization.
abstract: BACKGROUND
  Central venous catheter placement is a common procedure in the intensive care unit. However, these devices are not without complications. We describe the first reported case of descending necrotizing mediastinitis secondary to central venous catheterization without evidence of associated vascular perforation.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  A 24-year-old man developed descending necrotizing mediastinitis after exploratory laparotomy for a gunshot wound. A central venous catheter was presumed to be the source because blood, intraoperative, and catheter tip cultures grew the same Klebsiella organism, and there was no evidence of venous perforation at the initial operation.
  
  
  CONCLUSIONS
  Prompt recognition, adequate operative drainage, and appropriate antibiotics remain the best treatment for descending necrotizing mediastinitis.
authors.affiliation: Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Caputo
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Hauser
authors.forename: David H
authors.initials: DH
authors.lastname: Livingston
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000382:microbiology*; D004864:Equipment and Supplies / Q000382:microbiology; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification*; D007710:Klebsiella Infections / Q000382:microbiology*; D008297:Male; D008480:Mediastinitis / Q000382:microbiology*; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents