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Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome

OBJECTIVES: The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post...

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Autores principales: Hariri, Geoffroy, Genoud, Mathieu, Bruckert, Vincent, Chosidow, Samuel, Guérot, Emmanuel, Kimmoun, Antoine, Nesseler, Nicolas, Besnier, Emmanuel, Daviaud, Fabrice, Lagier, David, Imbault, Julien, Grimaldi, David, Bouglé, Adrien, Mongardon, Nicolas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817255/
https://www.ncbi.nlm.nih.gov/pubmed/36609390
http://dx.doi.org/10.1186/s13054-022-04277-6
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author Hariri, Geoffroy
Genoud, Mathieu
Bruckert, Vincent
Chosidow, Samuel
Guérot, Emmanuel
Kimmoun, Antoine
Nesseler, Nicolas
Besnier, Emmanuel
Daviaud, Fabrice
Lagier, David
Imbault, Julien
Grimaldi, David
Bouglé, Adrien
Mongardon, Nicolas
author_facet Hariri, Geoffroy
Genoud, Mathieu
Bruckert, Vincent
Chosidow, Samuel
Guérot, Emmanuel
Kimmoun, Antoine
Nesseler, Nicolas
Besnier, Emmanuel
Daviaud, Fabrice
Lagier, David
Imbault, Julien
Grimaldi, David
Bouglé, Adrien
Mongardon, Nicolas
author_sort Hariri, Geoffroy
collection PubMed
description OBJECTIVES: The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. METHODS: Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009–2019). RESULTS: Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17–61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43–65] vs. 65 [61–73] yo; p = 0.013), had lower body mass index (24 [20–26] vs. 30 [24–32] kg/m(2); p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28–40] vs. 54 [34–61]; p = 0.012). CONCLUSION: Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.
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spelling pubmed-98172552023-01-07 Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome Hariri, Geoffroy Genoud, Mathieu Bruckert, Vincent Chosidow, Samuel Guérot, Emmanuel Kimmoun, Antoine Nesseler, Nicolas Besnier, Emmanuel Daviaud, Fabrice Lagier, David Imbault, Julien Grimaldi, David Bouglé, Adrien Mongardon, Nicolas Crit Care Research OBJECTIVES: The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. METHODS: Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009–2019). RESULTS: Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17–61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43–65] vs. 65 [61–73] yo; p = 0.013), had lower body mass index (24 [20–26] vs. 30 [24–32] kg/m(2); p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28–40] vs. 54 [34–61]; p = 0.012). CONCLUSION: Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation. BioMed Central 2023-01-06 /pmc/articles/PMC9817255/ /pubmed/36609390 http://dx.doi.org/10.1186/s13054-022-04277-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Hariri, Geoffroy
Genoud, Mathieu
Bruckert, Vincent
Chosidow, Samuel
Guérot, Emmanuel
Kimmoun, Antoine
Nesseler, Nicolas
Besnier, Emmanuel
Daviaud, Fabrice
Lagier, David
Imbault, Julien
Grimaldi, David
Bouglé, Adrien
Mongardon, Nicolas
Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
title Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
title_full Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
title_fullStr Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
title_full_unstemmed Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
title_short Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
title_sort post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817255/
https://www.ncbi.nlm.nih.gov/pubmed/36609390
http://dx.doi.org/10.1186/s13054-022-04277-6
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