Mediastinitis after heart transplantation: clinical presentation and outcome
Abstract number: R2516
Farinas M.C., Arnaiz E., Vázquez de Prada J.A., Munoz P., Valerio M., Yañez J., Gurguí M., Galvez M.L., Álvarez M.T., Moreno A., Cervera C., Pérez-Villa F.
Objective: To assess the incidence, predisposing factors and outcome of mediastinitis after heart transplantation.
Methods: From January 1997 to December 2006, a total of 774 heart transplants were performed in four tertiary care university centres in Spain. Those cases with possible mediastinitis were identified from the hospital infection register and discharge register. Patients' charts were reviewed and cases of mediastinitis confirmed based on criteria of the Centers for Disease Control and Prevention.
Results: Mediastinitis developed in 13 (1.8%) of 774 cardiac transplant patients. Patient's ages ranged from 37 to 64 years (mean 54.3 y, SD=8.1) and 9 (69.2%) patients were males. The incubation period for mediastinitis ranged from 2 to 40 days (mean 13.1d, SD=12.2). Ten (76.9%) patients were diagnosed in the first 2 weeks after transplantation and only 1 case developed longer than l month after this procedure. Seven (53, 8%) patients were diabetic, and 1 had a previous heart transplant. Fever (84.6%), purulent secretion through the wound (86%) and sternal instability on palpation (76.9%) were the main clinical findings. Bacteraemia developed in 8 (61. 5%) patients: S. aureus was the most frequent microorganism isolated (3 patients, 1 MRSA), followed by S. epidermidis (2 patients), K. pneumoniae (1 patient), P. aeruginosa (1 patient) and S. viridans (1 patient). In the wound secretion or in the mediastinum or both S. aureus was identified in 5 patients (2 MRSA), S. epidermidis in 2, and K. pneumoniae, P. aeruginosa, Serratia marcescens and Candida glabrata in 1 patient each. All patients received antibiotic treatment. Surgical treatment was performed in 12 (92.3%) cases, and the extension of the debridement varied with local conditions. In 7 (53%) patients, additional irrigation of the closed wound with povidone-iodine was performed. Two (15.4%) patients died in the first month after the diagnosis, and the causes of death were related to the infection.
Conclusion: Promptness in diagnosing mediastinitis and precocious surgical drainage has changed the natural evolution of this disease. Nevertheless, observance of the basic precepts of prophylaxis of infection is still the best way to treat mediastinitis. Gram-positive organisms were more commonly isolated than were Gram-negative bacteria.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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