Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
Abstract 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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-01-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04277-6 |
| _version_ | 1797958674270912512 |
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| author | Geoffroy Hariri Mathieu Genoud Vincent Bruckert Samuel Chosidow Emmanuel Guérot Antoine Kimmoun Nicolas Nesseler Emmanuel Besnier Fabrice Daviaud David Lagier Julien Imbault David Grimaldi Adrien Bouglé Nicolas Mongardon |
| author_facet | Geoffroy Hariri Mathieu Genoud Vincent Bruckert Samuel Chosidow Emmanuel Guérot Antoine Kimmoun Nicolas Nesseler Emmanuel Besnier Fabrice Daviaud David Lagier Julien Imbault David Grimaldi Adrien Bouglé Nicolas Mongardon |
| author_sort | Geoffroy Hariri |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T00:22:21Z |
| format | Article |
| id | doaj.art-ce5e166645f247c88c3dc45e3053ccce |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-11T00:22:21Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-ce5e166645f247c88c3dc45e3053ccce2023-01-08T12:13:19ZengBMCCritical Care1364-85352023-01-0127111010.1186/s13054-022-04277-6Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcomeGeoffroy Hariri0Mathieu Genoud1Vincent Bruckert2Samuel Chosidow3Emmanuel Guérot4Antoine Kimmoun5Nicolas Nesseler6Emmanuel Besnier7Fabrice Daviaud8David Lagier9Julien Imbault10David Grimaldi11Adrien Bouglé12Nicolas Mongardon13Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne UniversitéService des urgences, Département de médecine aiguë, Hôpitaux Universitaires de GenèveDépartement d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne UniversitéService d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri MondorMédecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP)CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de LorraineService d’anesthésie-réanimation, CHU de RennesDépartement d’anesthésie-réanimation, CHU de RouenService de réanimation, Centre Cardiologique du NordService d’anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM)Service d’anesthésie réanimation sud, centre médico-chirurgical Magellan, CHU de BordeauxService de réanimation polyvalente, Hôpital Erasme, cliniques universitaires de BruxellesDépartement d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne UniversitéService d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri MondorAbstract 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.https://doi.org/10.1186/s13054-022-04277-6Cardiac surgeryMediastinitisNosocomial infectionHealthcare-associated infectionFungusCandida |
| spellingShingle | Geoffroy Hariri Mathieu Genoud Vincent Bruckert Samuel Chosidow Emmanuel Guérot Antoine Kimmoun Nicolas Nesseler Emmanuel Besnier Fabrice Daviaud David Lagier Julien Imbault David Grimaldi Adrien Bouglé Nicolas Mongardon Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome Critical Care Cardiac surgery Mediastinitis Nosocomial infection Healthcare-associated infection Fungus Candida |
| 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 | Cardiac surgery Mediastinitis Nosocomial infection Healthcare-associated infection Fungus Candida |
| url | https://doi.org/10.1186/s13054-022-04277-6 |
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