title: Descending necrotizing mediastinitis below the tracheal carina.
abstract: BACKGROUND
  Descending necrotizing mediastinitis is a dreadful disease with a high mortality rate, particularly when below the tracheal carina. This study describes the epidemiologic, clinical, and paraclinical features of patients treated for this condition.
  
  
  METHODS
  We performed a single-center retrospective descriptive review of 60 patients with descending necrotizing mediastinitis below the tracheal carina, who were treated during a 7-year period, the largest study in the last 50 years. Demographic, clinical, paraclinical, and therapeutic variables were analyzed.
  
  
  RESULTS
  43 (71.7%) patients were male. The mean age was 41.2 ± 14.7 years. Mean hospital length of stay was 25.0 ± 19.8 days. Comorbidities were present in 46.7% of patients, diabetes mellitus being the most common. Odontogenic infections (45%) were the most frequent source of descending necrotizing mediastinitis. Cultures showed Gram-negative bacilli in 68.3%, Gram-positive cocci in 38.3%, and fungi in 6.7%. Mortality was 35% (21 patients); risk factors for mortality were age (>35 years), diabetes mellitus among other comorbidities, and associated complications.
  
  
  CONCLUSIONS
  In this low socioeconomic status patient population, descending necrotizing mediastinitis below the carina causes high morbidity and mortality, the latter particularly associated with age, complications, diabetes mellitus and other comorbidities.
authors.affiliation: General Hospital of Mexico, Mexico City, Mexico.
authors.forename: Walid L
authors.initials: WL
authors.lastname: Dajer-Fadel
authors.forename: Carlos
authors.initials: C
authors.lastname: Ibarra-Pérez
authors.forename: Luis D
authors.initials: LD
authors.lastname: Sánchez-Velázquez
authors.forename: Rafael
authors.initials: R
authors.lastname: Borrego-Borrego
authors.forename: Francisco P
authors.initials: FP
authors.lastname: Navarro-Reynoso
authors.forename: Rubén
authors.initials: R
authors.lastname: Argüero-Sánchez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009336:Necrosis; D010348:Patient Care Team; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Drainage; mediastinitis; necrosis; sepsis; tracheotomy