title: Retrospective Review of Management and Outcomes of Pediatric Descending Mediastinitis.
abstract: To review the management and outcomes of pediatric patients treated for descending mediastinitis at a single institution and contribute to an updated mortality rate.
  
  
  
  Case series with chart review.
  
  
  
  Tertiary care pediatric hospital.
  
  
  
  This study is a 19-patient case series of all patients treated for descending mediastinitis at a tertiary pediatric hospital from 1997 to 2015, and it serves as an update to the case series published from this institution in 2008. Review of management included time to diagnosis, time to surgery, surgical procedures performed, and antibiotics administered. The primary outcomes measured were length of hospitalization and mortality.
  
  
  
  In addition to 8 previously reported patients, we identified 11 pediatric patients treated for descending mediastinitis in the period of review. All 19 patients were <18 months old, and all survived their hospitalization. Fourteen patients underwent surgical drainage at least twice. The median length of hospital stay was 15 days. Retropharyngeal abscess was the source of infection in 16 of 19 patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the isolated organism in 14 of 15 positive cultures.
  
  
  
  This review represents the largest reported series of pediatric patients with descending mediastinitis. With 100% survival, our results suggest that pediatric descending mediastinitis can be safely managed by prompt surgical drainage. Broad-spectrum antibiotics covering MRSA and a low threshold for repeat surgical intervention have been an important part of our successful approach and may decrease length of stay.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA cwilso88@uthsc.edu.
authors.forename: Caleb D
authors.initials: CD
authors.lastname: Wilson
authors.affiliation: University of Tennessee College of Medicine, Memphis, Tennessee, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kennedy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Wood
authors.affiliation: Division of Pediatric Cardiac Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: T K Susheel
authors.initials: TK
authors.lastname: Kumar
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Rose Mary S
authors.initials: RM
authors.lastname: Stocks
authors.affiliation: University of Tennessee College of Medicine, Memphis, Tennessee, USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Thompson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Jerome W
authors.initials: JW
authors.lastname: Thompson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D013714:Tennessee / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: mediastinitis; pediatric deep neck infections; retropharyngeal abscess