title: Factors associated with the mediastinal spread of cervical necrotizing fasciitis.
abstract: BACKGROUND
  We conducted a study to determine factors associated with the occurrence of mediastinitis in patients hospitalized for cervical necrotizing fasciitis (CNF).
  
  
  METHODS
  We reviewed the medical records of 130 consecutive patients in an intensive care unit (ICU) who were hospitalized with a diagnosis of CNF. Two radiologists reviewed cervical and thoracic computed tomography (CT) scans to determine the source and extension of the infection in each patient.
  
  
  RESULTS
  Among the cohort of 130 patients with CNF, 37 (28%) had mediastinitis at the time of their admission (which in 13 cases was superior, or above the aortic arch, and in 24 cases inferior). Cervical necrotizing fasciitis complicated by mediastinitis resulted in a longer stay in the ICU than did CNF without mediastinitis, of a mean of 29 days (range, 18 to 39 days) versus 14 days (range, 9 to 19) days, respectively (p<0.0001). Multivariate analysis revealed that the presence of mediastinitis was associated with oral intake of glucocorticoids before admission (odds ratio [OR], 2.17; range, 0.99 to 4.76), a pharyngeal focus of CNF (OR, 2.17; range, 1.04 to 4.53), or gas seen on an initial CT scan (OR, 4.49; range, 2.15 to 9.38). Both a pharyngeal focus of fasciitis and the presence of gas were strong independent predictors of inferior mediastinitis (OR, 15.1; range, 4.9 to 46.4; p<0.0001).
  
  
  CONCLUSIONS
  The present study is the first to describe three independent factors associated with extension of cervical fasciitis to the thoracic cavity, including glucocorticoid intake before admission, and confirms previous reports of a high incidence of mediastinitis in patients with CNF.
authors: Department of Anesthesiology and Critical Care, Lariboisière University Hospital, and University Paris 7, Paris, France.
authors: Franck
authors: F
authors: Petitpas
authors: Jean-Philippe
authors: JP
authors: Blancal
authors: Joaquim
authors: J
authors: Mateo
authors: Iyed
authors: I
authors: Farhat
authors: Walid
authors: W
authors: Naija
authors: Raphael
authors: R
authors: Porcher
authors: Catherine
authors: C
authors: Beigelman
authors: Mourad
authors: M
authors: Boudiaf
authors: Didier
authors: D
authors: Payen
authors: Philippe
authors: P
authors: Herman
authors: Alexandre
authors: A
authors: Mebazaa
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004322:Drainage / Q000379:methods*; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014140:Tracheotomy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents