title: [Streptococcal mediastinitis after thyroidectomy. A literature review].
abstract: BACKGROUND
  Surgical site infections after thyroid surgery are mostly superficial and can be well treated. Streptococcal mediastinitis in contrast is a rare but life-threatening complication.
  
  
  METHODS
  A 57-year-old female patient experienced septic fever, increase of inflammation parameters and erythema 2 days after thyroid surgery for Graves' disease. This process was triggered by a three-compartment infection by group A Streptococcus (GAS) with involvement of the mediastinum. Therapy over 6 weeks including seven wound revisions with the patient under general anesthesia, pathogen-adapted antibiotic treatment and cervical negative pressure treatment managed to control the infection. A total of 21 cases have been published on this phenomenon, 11 of which had a fatal outcome.
  
  
  CONCLUSIONS
  High fever and surgical site erythema in the early postoperative period after thyroid surgery can be signs of a GAS infection, which might lead to necrotizing, descending, life-threatening mediastinitis. Early diagnosis with support of computed tomography (CT) scans, immediate therapy including wound opening, lavage, intravenous antibiotic treatment with penicillin and clindamycin are vital. If treatment resistance occurs, cervical negative pressure treatment should be considered.
authors: II. Chirurgische Abteilung "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: C
authors: C
authors: Bures
authors: Hals-Nasen-Ohren-Abteilung, Krankenanstalt Rudolfstiftung, Wien Juchgasse 25, 1030, Wien, Österreich. valerie.zielinski@wienkav.at.
authors: V
authors: V
authors: Zielinski
authors: Universitätsklinik für Urologie, Allgemeines Krankenhaus Wien, Wien, Österreich.
authors: T
authors: T
authors: Klatte
authors: Universitätsklinik für Urologie, Allgemeines Krankenhaus Wien, Wien, Österreich.
authors: N
authors: N
authors: Swietek
authors: II. Chirurgische Abteilung "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: F
authors: F
authors: Kober
authors: II. Chirurgische Abteilung "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: E
authors: E
authors: Tatzgern
authors: II. Chirurgische Abteilung "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: R
authors: R
authors: Bobak-Wieser
authors: II. Chirurgische Abteilung "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: E
authors: E
authors: Gschwandtner
authors: Krankenhaushygiene, Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: M
authors: M
authors: Gilhofer
authors: Krankenhaushygiene, Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: A
authors: A
authors: Wechsler-Fördös
authors: II. Chirurgische Abteilung "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Wien, Österreich.
authors: M
authors: M
authors: Hermann
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008480:Mediastinitis / Q000209:etiology* / Q000628:therapy*; D008875:Middle Aged; D013290:Streptococcal Infections / Q000209:etiology* / Q000628:therapy*; D013297:Streptococcus pyogenes; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy*; D013965:Thyroidectomy
keywords: Antibiotics; Mediastinitis; Negative pressure therapy; Streptococcus; Thyroidectomy
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