Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome

Critical Care

Research

Antoine Kimmoun¹  Adrien Bouglé²  Geoffroy Hariri³  Vincent Bruckert⁴  Emmanuel Besnier⁵  Emmanuel Guérot⁶  David Grimaldi⁷  Fabrice Daviaud⁸  Mathieu Genoud⁹  David Lagier^1,10  Julien Imbault^1,11  Samuel Chosidow^1,12  Nicolas Mongardon^1,13  Nicolas Nesseler^1,14 

[1] CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine, 54000, Nancy, France;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;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;Institut Pierre Louis d’épidémiologie et de santé publique, Inserm U1136, Sorbonne Université, 75013, Paris, France;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;Service d’anesthésie-réanimation, CHU de Nice, 06000, Nice, France;Département d’anesthésie-réanimation, CHU de Rouen, 76000, Rouen, France;UNIROUEN, Inserm U1096, Normandie Univ, 76000, Rouen, France;Médecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015, Paris, France;Service de réanimation polyvalente, Hôpital Erasme, cliniques universitaires de Bruxelles, 1070, Brussels, Belgium;Service de réanimation, Centre Cardiologique du Nord, 93200, Saint-Denis, France;Service des urgences, Département de médecine aiguë, Hôpitaux Universitaires de Genève, 1205, Geneva, Switzerland;Service d’anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 13000, Marseille, France;Service d’anesthésie réanimation sud, centre médico-chirurgical Magellan, CHU de Bordeaux, 33600, Pessac, France;Inserm, UMR 1034, Biology of Cardiovascular Diseases, Univ. Bordeaux, 33000, Bordeaux, France;Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France;Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France;U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), 94700, Maisons-Alfort, France;Faculté de Santé, Univ Paris Est Créteil, 94010, Créteil, France;Service d’anesthésie-réanimation, CHU de Rennes, 35000, Rennes, France;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;

关键词: Cardiac surgery;    Mediastinitis;    Nosocomial infection;    Healthcare-associated infection;    Fungus;    Candida;    Aspergillus;    Trichosporon;   

DOI  :  10.1186/s13054-022-04277-6

 received in 2022-10-02, accepted in 2022-12-10,  发布年份 2022

来源: Springer

【 摘 要 】

ObjectivesThe 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.MethodsMulticenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009–2019).ResultsAmong 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).ConclusionFungal 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.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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