A comparatıve study of the rare but deadly ınfectıon: post-sternotomy medıastınıtıs and descendıng necrotızıng medıastınıtıs wıth an analysıs of outcome-determınıng factors

Öz

Aim: Mediastinitis, a rare yet serious infection, affects the mediastinum. This study aims to compare the demographic, clinical, and laboratory characteristics of patients diagnosed with post-sternotomy mediastinitis (PSM) or descending necrotizing mediastinitis (DNM) to identify features of non-surviving patients. Material and Methods: This study included patients diagnosed with PSM and DNM between 2015 and 2022 at the Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital Patients were categorized and compared as survivors and non-survivors. Results: This study included 25 patients diagnosed with mediastinitis. The average age was 54.9 ± 12.1, with 64% being male. Blood cultures were obtained from 92% of patients. Purulent discharge cultures were sent for 88% of patients, with 44% showing growth. Comorbidities were present in 84% and the prevalence of comorbidities, sepsis, and intensive care unit (ICU) hospitalization after diagnosis was significantly higher in PSM patients (p=0.017, p=0.004, p=0.026). Heart failure, coronary artery disease (CAD), and hypertension (HT) were significantly higher in PSM patients (ps=0.000). PSM patients were also significantly more common in the non-survivor group (p=0.012). The non-survivor group had higher average age, more smokers, and longer intensive care unit stays post-diagnosis (p=0.046, p=0.049, p=0.038). Patients with PSM, HT, and CAD were significantly more common in the non-survivor group (p=0.012, p=0.008, p=0.033). Conclusion: Mediastinitis is a rare but serious condition with high mortality and morbidity rates. In patients with a higher risk of mortality, such as the elderly, smokers, patients with median sternotomy, and those with comorbidities, treatment and follow-up strategies can be improved.

Anahtar Kelimeler

• Mediastinitis
• post-sternotomy mediastinitis
• descending necrotizing mediastinitis
• comorbidities
• mortality

Etik Beyan

This study has received ethical approval from the Ankara Etlik City Hospital Ethics Committee (approval no: AEŞH-EK1-2023-491, approval date: 06.09.2023).

Nadir ancak ölümcül bir enfeksiyon üzerine karşılaştırmalı bir çalışma: Post-sternotomi mediastinit ve descending nekrotizan mediastinitte sonucu belirleyici faktörlerin analizi

Öz

Amaç: Mediastinit; nadir görülen ciddi bir enfeksiyondur. Bu çalışmanın amacı, post-sternotomi mediastinit (PSM) veya descending nekrotizan mediastinit (DNM) tanısı alan hastaların demografik, klinik ve laboratuvar özelliklerini karşılaştırmak ve mortalite görülen hastaların özelliklerini belirlemektir. Gereç ve Yöntemler: Bu çalışmaya 2015-2022 yılları arasında Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi'nde PSM ve DNM tanısı alan hastalar dahil edilmiştir. Hastalar hayatta kalanlar ve kalamayanlar olarak kategorize edilmiştir ve karşılaştırılmıştır. Bulgular: Bu çalışmaya mediastinit tanısı konulan 25 hasta dahil edilmiştir. Ortalama yaş 54.9 ± 12.1 olup, hastaların %64'ü erkekti. Hastaların %92'sinden kan kültürü alınmıştır. Hastaların %88'inden pürülan akıntı kültürleri gönderilmiştir, %44'ünde üreme tespit edilmiştir. Hastaların %84'ünde komorbidite mevcuttur ve komorbidite varlığı, sepsis varlığı ve tanı sonrası yoğunbakım ünitesinde (YBÜ) yatış günü prevalansı PSM hastalarında anlamlı olarak daha yüksekti (p=0.017, p=0.004, p=0.026). Kalp yetmezliği, koroner arter hastalığı (KAH) ve hipertansiyon (HT) PSM hastalarında anlamlı olarak daha yüksekti (ps=0.000). PSM hastaları; hayatta kalamayan grupta da anlamlı olarak daha yaygındı (p=0.012). Hayatta kalamayan grupta yaş ortalaması daha yüksek, sigara içenlerin sayısı daha fazla ve tanı sonrası YBÜ'de kalma süresi daha uzundu (p=0,046, p=0,049, p=0,038). PSM, HT ve KAH olan hastalar hayatta kalamayan grupta anlamlı olarak daha yaygındı (p=0.012, p=0.008, p=0.033). Sonuç: Mediastinit; nadir görülen ancak yüksek mortalite ve morbidite oranlarına sahip ciddi bir enfeksiyondur. Yaşlılar, sigara içenler, median sternotomi yapılanlar ve komorbiditeleri olanlar gibi mortalite riski daha yüksek olan hastalarda tedavi ve takip stratejileri geliştirilebilir.

Anahtar Kelimeler

• Mediastinit
• post-sternotomy mediastinitis
• descending necrotizing mediastinitis
• comorbidity
• ölüm

Kaynakça

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