JOPIC
Journal of Pulmonology and Intensive Care

The JoPIC is an independent-unbiased, peer-reviewed, and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, surgical techniques, differential diagnoses, editorial opinions, letters to the editor, and educational papers in pulmonology, thoracic surgery, occupational diseases, allergology, and intensive care medicine. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

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A current approach to acute mediastinitis
Abstract
Acute mediastinitis is still among the major causes of high mortality despite advances in antibiotic therapies, intensive care support, and novel diagnostic techniques. Mediastinitis may develop due to esophageal perforation, by a downward spread of neck infection, or after cardiothoracic surgery. While computed tomography is the most preferred imaging technique in diagnosis, broad-spectrum antibiotic therapy and surgical debridement are the mainstay of the treatment. It is essential to combine multiple interventions, such as appropriate antimicrobial prophylaxis, minimization of contamination, elimination of preoperative nasal S. aureus carriage, and the adoption of relevant surgical techniques, to prevent particularly postoperative mediastinitis.

Keywords : Acute mediastinitis, antibiotic therapy, surgical debridement

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1. Palma DM, Giuliano S, Cracchiolo AN, et al. Clinical features andoutcome of patients with descending necrotizing mediastinitis:prospective analysis of 34 cases. Infection. 2016;44(1):77-84. doi:10.1007/s15010-015-0838-y
2. Biancari F, D’Andrea V, Paone R, et al. Current treatment and outcomeof esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg. 2013;37(5):1051-1059. doi:10.1007/s00268-013-1951-7
3. Abu-Omar Y, Kocher GJ, Bosco P, et al. European Associationfor Cardio-Thoracic Surgery expert consensus statement on theprevention and management of mediastinitis. Eur J Cardiothorac Surg.2017;51(1):10-29. doi:10.1093/ejcts/ezw326
4. Ridder GJ, Maier W, Kinzer S, Teszler CB, Boedeker CC, Pfeiffer J.Descending necrotizing mediastinitis: contemporary trends in etiology,diagnosis, management, and outcome. Ann Surg. 2010;251(3):528-534.doi:10.1097/SLA.0b013e3181c1b0d1
5. Centers for Disease Control and Prevention. CDC/NHSN surveillancedefinitions for specific types of infections. https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf (Accessed on April 10, 2017)
6. Perrault LP, Kirkwood KA, Chang HL, et al. A Prospective Multi-Institutional Cohort Study of Mediastinal Infections After CardiacOperations. Ann Thorac Surg. 2018;105(2):461-468. doi:10.1016/j.athoracsur.2017.06.078
7. Filsoufi F, Castillo JG, Rahmanian PB, et al. Epidemiology of deepsternal wound infection in cardiac surgery. J Cardiothorac Vasc Anesth.2009;23(4):488-494. doi:10.1053/j.jvca.2009.02.007
8. Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis aftercoronary artery bypass grafting risk factors and long-term survival. AnnThorac Surg. 2010;89(5):1502-1509. doi:10.1016/j.athoracsur.2010.02.038
9. Friedman ND, Bull AL, Russo PL, et al. An alternative scoring systemto predict risk for surgical site infection complicating coronary arterybypass graft surgery. Infect Control Hosp Epidemiol. 2007;28(10):1162-1168. doi:10.1086/519534
10. Tanner J, Norrie P, Melen K. Preoperative hair removal to reducesurgical site infection. Cochrane Database Syst Rev. 2011;(11):CD004122.doi:10.1002/14651858.CD004122.pub4
11. Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descendingnecrotizing mediastinitis. Surg Gynecol Obstet. 1983;157(6):545-552.
12. Ryom P, Ravn JB, Penninga L, et al. Aetiology, treatment andmortality after oesophageal perforation in Denmark. Dan Med Bull.2011;58(5):A4267.
13. Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC.Evolving options in the management of esophageal perforation. AnnThorac Surg. 2004;77(4):1475-1483. doi:10.1016/j.athoracsur.2003.08.037
14. Norder Grusell E, Dahlén G, Ruth M, et al. Bacterial flora of thehuman oral cavity, and the upper and lower esophagus. Dis Esophagus.2013;26(1):84-90. doi:10.1111/j.1442-2050.2012.01328.x
15. Graeber GM, McClelland WT. Current concepts in the managementand reconstruction of the dehisced median sternotomy. Semin ThoracCardiovasc Surg. 2004;16(1):92-107. doi:10.1053/j.semtcvs.2004.01.008
16. Exarhos DN, Malagari K, Tsatalou EG, et al. Acute mediastinitis:spectrum of computed tomography findings. Eur Radiol.2005;15(8):1569-1574. doi:10.1007/s00330-004-2538-3
17. Falagas ME, Tansarli GS, Kapaskelis A, Vardakas KZ. Impact ofvacuum-assisted closure (VAC) therapy on clinical outcomes of patientswith sternal wound infections: a meta-analysis of non-randomizedstudies. PLoS One. 2013;8(5):e64741. doi:10.1371/journal.pone.0064741
18. Sandner A, Börgermann J. Update on necrotizing mediastinitis:causes, approaches to management, and outcomes. Curr Infect Dis Rep.2011;13(3):278-286. doi:10.1007/s11908-011-0174-z
19. Kiernan PD, Hernandez A, Byrne WD, et al. Descending cervicalmediastinitis. Ann Thorac Surg. 1998;65(5):1483-1488. doi:10.1016/s0003-4975(98)00142-8
20. Singhal P, Kejriwal N, Lin Z, Tsutsui R, Ullal R. Optimal surgicalmanagement of descending necrotising mediastinitis: our experienceand review of literature. Heart Lung Circ. 2008;17(2):124-128.doi:10.1016/j.hlc.2007.08.004
21. Abbas G, Schuchert MJ, Pettiford BL, et al. Contemporaneousmanagement of esophageal perforation. Surgery. 2009;146(4):749-756.doi:10.1016/j.surg.2009.06.058
22. Ben-David K, Behrns K, Hochwald S, et al. Esophageal perforationmanagement using a multidisciplinary minimally invasive treatmentalgorithm. J Am Coll Surg. 2014;218(4):768-774. doi:10.1016/j.jamcollsurg.2013.12.033
23. Salo JA, Isolauri JO, Heikkilä LJ, et al. Management of delayedesophageal perforation with mediastinal sepsis. Esophagectomy orprimary repair?. J Thorac Cardiovasc Surg. 1993;106(6):1088-1091.
24. Vogel SB, Rout WR, Martin TD, Abbitt PL. Esophageal perforationin adults: aggressive, conservative treatment lowers morbidityand mortality. Ann Surg. 2005;241(6):1016-1023. doi:10.1097/01.sla.0000164183.91898.74
25. Engelman R, Shahian D, Shemin R, et al. The Society of ThoracicSurgeons practice guideline series: Antibiotic prophylaxis in cardiacsurgery, part II: Antibiotic choice. Ann Thorac Surg. 2007;83(4):1569-1576. doi:10.1016/j.athoracsur.2006.09.046
26. Itagaki S, Cavallaro P, Adams DH, Chikwe J. Bilateral internalmammary artery grafts, mortality and morbidity: an analysis of 1526 360 coronary bypass operations. Heart. 2013;99(12):849-853.doi:10.1136/heartjnl-2013-303672
27. Deo SV, Shah IK, Dunlay SM, et al. Bilateral internal thoracic arteryharvest and deep sternal wound infection in diabetic patients. AnnThorac Surg. 2013;95(3):862-869. doi:10.1016/j.athoracsur.2012.11.068
28. Bryan CS, Yarbrough WM. Preventing deep wound infectionafter coronary artery bypass grafting: a review. Tex Heart Inst J.2013;40(2):125-139.
Article available in :
Volume 1, Issue 2, 2023
Page : 38-41
https://doi.org/10.51271/JOPIC-0009
Article Information
Received : 22 Nis 2023
Accepted : 09 May 2023
Published : 22 May 2023
Corresponding Author :

Sengül Üçer: University of Health Science, Ankara Education and Research Hospital, Infectious Diseases and Clinical Microbiology Clinic, Ankara

[email protected]
Citation : Üçer S. A current approach to acute mediastinitis. J Pulmonol Intens Care. 2023;1(2):38-41.

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