Risk factors for mortality in patients with mediastinitis after cardiac surgery.
BACKGROUND
Patients with mediastinitis after cardiac surgery have higher morbidity and mortality.


OBJECTIVE
Describe the characteristics of patients with mediastinitis, determine the mortality within one month, and assess the risk factors associated with mortality.


METHODS
Retrospective cohort study including all adult patients with mediastinitis during the 2002-2006 period at the Nantes University Hospital. Multivariate analysis by logistic regression and Kaplan-Meier curve of survey were done.


RESULTS
Nearly 5574 patients were operated during the study period, with a mediastinitis incidence rate of 0.7%, 28 patients (72%) had coronary artery bypass graft. The mortality rate increased from de 12.8% during hospital stay to 20.5% within one year. Only two deaths were associated with mediastinitis. The occurrence of a co-infection was the only independent risk factor associated with mortality (OR 13, P<0.04). The instantaneous risk of death was increased by 7 in patient with co-infection, particularly mechanical ventilator-associated pneumonia (CR 1,97).


CONCLUSIONS
Mortality varied according to the duration of surveillance, and mediastinitis was not the major cause of death. Mechanical ventilator-associated pneumonia after mediastinitis increases the mortality and needs specific prevention.
Lepelletier
Didier
D
Service de bactériologie-hygiène, CHU de Nantes, 44000 Nantes, France. didier.lepelletier@chu-nantes.fr
Poupelin
Luc
L
Corvec
Stéphane
S
Bourigault
Céline
C
Bizouarn
Philippe
P
Blanloeil
Yvonnic
Y
Reynaud
Alain
A
Duveau
Daniel
D
Despins
Philippe
P
D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008480:Mediastinitis / Q000382:microbiology / Q000401:mortality*; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors