title: Aspergillus mediastinitis after cardiac surgery.
abstract: BACKGROUND
  Mediastinitis is a serious complication after cardiac surgery. While bacteria are the more common pathogens, fungal infections are rare. In particular, several cases of postoperative Aspergillus mediastinitis have been reported, the majority of which had an extremely poor outcome.
  
  
  METHODS
  A case of mediastinitis in a 42-year-old patient due to Aspergillus fumigatus after cardiac surgery is described. Two main risk factors were found: cardiogenic shock requiring veno-arterial extracorporeal life support and failure of primary closure of the sternum. A full recovery was attained after surgical drainage and antifungal therapy with liposomal amphotericin B, followed by a combination of voriconazole and caspofungin. The patient was followed for 18 months without relapse.
  
  
  RESULTS
  This is an extremely rare case of postoperative Aspergillus mediastinitis exhibiting a favourable outcome. Based on a systematic review of the literature, previous cases were examined with a focus on risk factors, antifungal therapies, and outcomes.
  
  
  CONCLUSIONS
  The clinical features of postoperative Aspergillus mediastinitis may be paucisymptomatic, emphasizing the need for a low index of suspicion in cases of culture-negative mediastinitis or in indolent wound infections. In addition to surgical debridement, the central component of antifungal therapy should include amphotericin B or voriconazole.
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
authors: Marie-Josée
authors: MJ
authors: Caballero
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. Electronic address: nicolas.mongardon@aphp.fr.
authors: Nicolas
authors: N
authors: Mongardon
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
authors: Hakim
authors: H
authors: Haouache
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
authors: Dominique
authors: D
authors: Vodovar
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
authors: Issam
authors: I
authors: Ben Ayed
authors: Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
authors: Lauriane
authors: L
authors: Auvergne
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Service de Chirurgie Cardiaque, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors: Marie-Line
authors: ML
authors: Hillion
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Unité de Mycologie, Département de Microbiologie, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors: Françoise
authors: F
authors: Botterel
authors: Université Paris Est, Faculté de Médecine, Créteil, France; Service d'Anesthésie et des Réanimations Chirurgicales, Assistance Publique des Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
authors: Gilles
authors: G
authors: Dhonneur
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D001232:Aspergillus fumigatus; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use; D008480:Mediastinitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D054714:Echinocandins; D055666:Lipopeptides; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole
keywords: Aspergillosis; Aspergillus fumigatus; Cardiac surgery; Mediastinitis; Nosocomial infection