Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience
Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years...
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-05-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/5/664 |
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| author | Angela De Palma Mirko Girolamo Cantatore Francesco Di Gennaro Francesca Signore Teodora Panza Debora Brascia Giulia De Iaco Doroty Sampietro Rosatea Quercia Marcella Genualdo Ondina Pizzuto Giuseppe Garofalo Fabio Signorile Davide Fiore Bavaro Gaetano Brindicci Nicolò De Gennaro Annalisa Saracino Nicola Antonio Adolfo Quaranta Gianfranco Favia Giuseppe Marulli |
| author_facet | Angela De Palma Mirko Girolamo Cantatore Francesco Di Gennaro Francesca Signore Teodora Panza Debora Brascia Giulia De Iaco Doroty Sampietro Rosatea Quercia Marcella Genualdo Ondina Pizzuto Giuseppe Garofalo Fabio Signorile Davide Fiore Bavaro Gaetano Brindicci Nicolò De Gennaro Annalisa Saracino Nicola Antonio Adolfo Quaranta Gianfranco Favia Giuseppe Marulli |
| author_sort | Angela De Palma |
| collection | DOAJ |
| description | Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo’s classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy. |
| first_indexed | 2024-03-10T03:27:28Z |
| format | Article |
| id | doaj.art-91183a4daa68453192a0192b491f9075 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T03:27:28Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-91183a4daa68453192a0192b491f90752023-11-23T09:49:22ZengMDPI AGAntibiotics2079-63822022-05-0111566410.3390/antibiotics11050664Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center ExperienceAngela De Palma0Mirko Girolamo Cantatore1Francesco Di Gennaro2Francesca Signore3Teodora Panza4Debora Brascia5Giulia De Iaco6Doroty Sampietro7Rosatea Quercia8Marcella Genualdo9Ondina Pizzuto10Giuseppe Garofalo11Fabio Signorile12Davide Fiore Bavaro13Gaetano Brindicci14Nicolò De Gennaro15Annalisa Saracino16Nicola Antonio Adolfo Quaranta17Gianfranco Favia18Giuseppe Marulli19Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyClinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyClinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyClinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyClinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyClinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyClinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyOtolaringology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyComplex Unit of Odontostomatology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyUnit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, ItalyDescending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 ± 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo’s classification). Mean time between diagnosis and treatment was 2.24 ± 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.https://www.mdpi.com/2079-6382/11/5/664descending necrotizing mediastinitisearly diagnosissurgical treatmentthoracotomycervicotomyantimicrobial therapy |
| spellingShingle | Angela De Palma Mirko Girolamo Cantatore Francesco Di Gennaro Francesca Signore Teodora Panza Debora Brascia Giulia De Iaco Doroty Sampietro Rosatea Quercia Marcella Genualdo Ondina Pizzuto Giuseppe Garofalo Fabio Signorile Davide Fiore Bavaro Gaetano Brindicci Nicolò De Gennaro Annalisa Saracino Nicola Antonio Adolfo Quaranta Gianfranco Favia Giuseppe Marulli Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience Antibiotics descending necrotizing mediastinitis early diagnosis surgical treatment thoracotomy cervicotomy antimicrobial therapy |
| title | Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience |
| title_full | Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience |
| title_fullStr | Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience |
| title_full_unstemmed | Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience |
| title_short | Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience |
| title_sort | multidisciplinary approach in the treatment of descending necrotizing mediastinitis twenty year single center experience |
| topic | descending necrotizing mediastinitis early diagnosis surgical treatment thoracotomy cervicotomy antimicrobial therapy |
| url | https://www.mdpi.com/2079-6382/11/5/664 |
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