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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.
Afiliación
  • Hariri G; Département d'anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France.
  • Genoud M; Institut Pierre Louis d'épidémiologie et de santé publique, Inserm U1136, Sorbonne Université, 75013, Paris, France.
  • Bruckert V; Service des urgences, Département de médecine aiguë, Hôpitaux Universitaires de Genève, 1205, Geneva, Switzerland.
  • Chosidow S; Département d'anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université, 75013, Paris, France.
  • Guérot E; Service d'anesthésie-réanimation, CHU de Nice, 06000, Nice, France.
  • Kimmoun A; Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France.
  • Nesseler N; Médecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015, Paris, France.
  • Besnier E; CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine, 54000, Nancy, France.
  • Daviaud F; Service d'anesthésie-réanimation, CHU de Rennes, 35000, Rennes, France.
  • Lagier D; CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d'Investigation Clinique de Rennes), Univ Rennes, 35000, Rennes, France.
  • Imbault J; Département d'anesthésie-réanimation, CHU de Rouen, 76000, Rouen, France.
  • Grimaldi D; UNIROUEN, Inserm U1096, Normandie Univ, 76000, Rouen, France.
  • Bouglé A; Service de réanimation, Centre Cardiologique du Nord, 93200, Saint-Denis, France.
  • Mongardon N; Service d'anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13000, Marseille, France.
Crit Care ; 27(1): 6, 2023 01 06.
Article en En | MEDLINE | ID: mdl-36609390
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/m2; 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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Cardíacos / Mediastinitis Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Crit Care Año: 2023 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Cardíacos / Mediastinitis Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: Crit Care Año: 2023 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido