Résumé
La médiastinite est une complication rare mais sévère de la chirurgie cardiaque effectuée par sternotomie. Cette infection associée aux soins se développe au niveau du médiastin antérieur et du sternum. En raison d’un choc septique ou mixte, ces patients peuvent nécessiter une prise en charge en réanimation. La proportion croissante d’opérés plus âgés ou avec des comorbidités multiples, fait que cette infection est encore associée à une mortalité élevée et à une prolongation de la durée d’hospitalisation.
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éférences
Définition des infections associées aux soins, mai 2007. Ministère de la Santé http://www.sante.gouv.fr
Mangram AJ, Horan TC, Pearson ML, et al. (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27: 97–132
Trouillet JL, Vuagnat A, Combes A, et al. (2005) Acute posternotomy mediastinitis managed with debridement and closed drainage irrigation: factors associated with death in the intensive care. J Thorac Cardiovasc Surg 129: 518–24
Borger MA, Rao V, Weisel RD, et al. (1999) Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg 1998; 65: 1050–6
Baskett RJ, MacDougall CE, Ross DB (?) Is mediastinitis a preventable complication, a 10-year review? Ann Thorac Surg 67: 462–5
National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 to June 2002, issued August 2002 (2002) Am J Inect Control 30: 458–75
Gummert JF, Barten MJ, Hans C, et al. (2002) Mediastinitis and cardiac surgery-an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 50: 87–9
Gardlund B, Bitkover CY, Vaage J (2002) Postoperative mediastinitis in cardiac surgery-microbiology and pathogenesis. Eur J Cardiothorac Surg 21: 824–30
Olsen MA, Lock-Buckley P, Hopkins D, et al. (2002) The risk factors for deep and superficial chest surgical site infections after coronary artery bypass graft surgery are different. J Thorac Cardiovasc Surg 124: 136–45
Lu JC, Grayson AD, Jha P, et al. (2003) Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. Eur J Cardiothorac Surg 23: 943–9
Sharma M, Berriel-Cass D, Baran J Jr (2004) Sternal surgical-site infection following coronary artery bypass graft: prevalence, microbiology, and complications during a 42-month period. Infect Control Hosp Epidemiol 25: 463–71
Crabtree TD, Codd JE, Fraser VJ, et al. (2004) Multivariate analysis of risk factors for deep and superficial sterna infection after coronary artery bypass grafting at a tertiary care medical center. Semin Thorac Cardiovasc Surg 16: 53–61
Lepelletier D, Perron S, Bizouarn P, et al. (2005) Surgical-site infection after cardiac surgery: incidence, microbiology, and risk factors. Infect Control Hosp Epidemiol 26: 466–72
Eklund AM, Lyytikainen O, Klemets P, et al. (2006) Mediastinitis after more than 10,000 cardiac surgical procedures. Ann Thorac Surg 82: 1784–9
Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL (2010) Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. Ann Thorac Surg 89: 1502–10
Abboud CS, Wey SB, Baltar VT (2004) Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg 77: 676–83
Senechal M, Leprince P, Tezenas du Montcel S, et al. (2004) Bacterial mediastinitis after heart transplantation: clinical presentation, risk factors and treatment. J Heart Lung Transplant 23: 165–70
Filsoufi F, Rahmanian PB, Castillo JG, et al. (2007) Incidence, treatment strategies, and outcome of deep sternal wound infection after orthotopic heart transplantation. J Heart Lung Transplant 26: 1084–90
Bou R, Peris M, Perpinan J, et al. (2004) A protracted outbreak of Staphylococcus epidermidis infections among patients undergoing valve replacement. Infect Control Hosp Epidemiol 25: 498–503
Jakob HG, Borneff-Lipp M, Bach A, et al. (2000) The endogenous pathway is a major route for deep sterna wound infection. Eur J Cardiothorac Surg 17: 154–60
San Juan R, Chaves F, Lopez Gude MJ, et al. (2007) Staphylococcus aureus post-sternotomy mediastinitis: description of two distinct acquisition pathways with different potential preventive approaches. J Thorac Cardiovasc Surg 134: 670–6
Le Guillou V, Tavolacci MP, Baste JM, et al. (2011) Surgical site infection after central venous catheter-related infection in cardiac surgery. Analysis of a cohort of 7557 patients. J Hosp Infect 79: 236–41
Lowry PW, Blankenship RJ, Gridley W, et al. (1991) A cluster of Legionella sternal wound infections due to post-operative topical exposure to contaminated tap water. N Engl J Med 324: 109–13
Parisian Mediastinitis study Group (1996) Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 11: 1200–7
El Oakley R, Paul E, Wong PS, et al. (1997) Mediastinitis in patients undergoing cardiopulmonary bypass: risk analysis and midterm results. J Cardiovasc Surg 38: 595–600
Birkmeyer NJ, Charlesworth DC, Hernandez F (1998) Obesity and risk of adverse outcomes associated with coronary artery bypass. Circulation 97: 1689–94
Wang FD, Chang CH (2000) Risk factors of deep sternal wound infections in coronary artery bypass graft surgery. J Cardiovasc Surg 41: 709–13
Ridderstolpe L, Gil H, Granfeldt H, et al. (2001). Superfical and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 20: 1168–75
Fowler VG, O’Brien SM, Muhlbaier LH, et al. (2005) Clinical predictors of major infections after cardiac surgery. Circulation 112(Suppl I): 358–65
Lopez Gude MJ, San Juan R, Aguado JM, et al. (2006) Case-Control study of risk factors for mediastinitis after cardiovascular surgery. Infect Control Hosp Epidemiol 27: 1397–1400
Diez C, Koch D, Kuss O, et al. (2007). Risk factors for mediastinitis after cardiac surgery-a retrospective analysis of 1700 patients. J Cardiothorac Surg 2: 23
Kluytmans JA, Mouton JW, VandenBergh MF, et al. (1996) Reduction of surgicalsite infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 17: 780–5
De Paulis R, de Notaris S, Scaffa R, et al. (2005) The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: the role of skeletonization. J Thorac Cardiovasc Surg 129: 536–43
Ko W, Lazenby D, Zelano JA, et al. (1991) Effects of shaving methods and intra operative irrigation on suppurative mediastinitis after by pass operations. Ann Thorac Surg 53: 301–5
Borer A, Gilad J, Meydan N, et al. (2001) Impact of active monitoring of infection control practices on deep sternal infection after open-heart surgery. Ann Thorac Surg 72: 515–20
Garey KW, Dao T, Chen H, et al. (2006) Timing of vancomycin prophylaxis for cardiac surgery and the risk of surgical site infections. J Antimicrob Chemother 58: 645–50
Holman WL, Rayburn BK, McGiffin DC, et al. (2003) Infection in ventricular assist devices: prevention and treatment. Ann Thorac Surg 75: S48–57
Trouillet JL, Combes A, Luyt CE, Chastre J (2007) Médiastinites après chirurgie cardiaque. Actualités en Réanimation et Urgences 294-305
Dörge H, Schöndube FA, Dörge P, et al. (2003) Procalcitonin is a valuable prognostic marker in cardiac surgery but not specific for infection. Thorac Cardiovasc Surg 51: 322–6
San Juan R, Aguado JM, López MJ, et al. (2005) Accuracy of blood culture for early diagnosis of mediastinitis in febrile patients after cardiac surgery. Eur J Clin Microbiol Infect Dis 24: 182–9
Fowler VG Jr, Kaye KS, Simel DL, et al. (2003) Staphylococcus aureus bacteremia after median sternotomy: clinical utility of blood culture results in the identification of postoperative mediastinitis. Circulation 108: 73–8
Bitkover CY, Cederlund K, Aberg B, Vaage J (1999) Computed tomography of the sternum and mediastinum after median sternotomy. Ann Thorc Surg 68: 858–63
Benlolo S, Mateo J, Raskine L, et al. (2003) Sternal puncture allows an early diagnosis of poststernotomy mediastinitis. J Thorac Cardiovasc Surg 125: 611–5
Mekontso-Dessap A, Honore S, Kirsch M, et al. (2004) Usefulness of routine epicardial pacing wire culture for early prediction of poststernotomy mediastinitis. J Clin Microbiol 42: 5245–48
Sjögren J, Malmsjö M, Gustafsson R, Ingemansson R (2006) Poststernotomy mediastinitis: a review of conventional surgical treatments, vacuum assited closure therapy and presentation of the Lund University Hospital mediastinis algorithm. Eur J Cardiothorac surg 30: 898–905
Jarlier V, Trystram D, Brun-Buisson C, et al. (2010) Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program. Arch Intern Med 170: 552–9
De Foe M, Gregorio R, Delia Corte A, et al. (2001) Deep sternal wound infection: the role of early debridement surgery. Eur J Cardiothorac Surg 19: 811–16
Poncelet AJ, Lengele B, Delaere B, et al. (2008) Algorithm for primary closure in sternal wound infection: a single institution 10-year experience. Eur J Cardiothorac Surg 33: 232–8
Fleck TM, Koller R, Giovanoli P, et al. (2004) Primary or delayed closure for the treatment of poststernotomy wound infections? Ann Plast Surg 52: 310–4
De Feo M, Vicchio M, Santé P, et al. (2011) Evolution in the treatment of mediastinitis: single-center experience. Asian Cardiovasc Thorac Ann 19: 39–43
Durandy Y, Batisse A, Bourel P, et al. (1989) Mediastinal infection after cardiac operation: a simple closed technique. J Thorac Cardiovasc Surg 97: 282–5
Calvat, Trouillet JL, Nataf P, et al. (1996) Closed drainage using Redon catheters for local treatment of post sternotomy mediastinitis. Ann Thorac Surg 61: 195–201
Berg HF, Brands W, van Geldorp T, et al. (2000) Comparison between closed drainage techniques for the treatment of postoperative mediastinitis. Ann Thorac Surg 70: 924–9
Kirsch M, Mekontso-Dessap A, Houël R, et al. (2001) Closed drainage using redon catheters for poststernotomy mediastinitis: results and risk factors for adverse outcome. Ann Thorac Surg 71: 1580–6
Merrill WH, Akhter SA, Wolf RK, et al. (2004) Simplified treatment of postoperative mediastinitis. Ann Thorac Surg 78: 608–12
Jones G, Jurkiewicz MJ, Bostwick J, et al. (1997) Management of the infected median sternotomy wound with muscle flaps. The Emory 20-year experience. Ann Surg 225: 766–76
El Gamel A, Yonan NA, Hassan R, et al. (1998) Treatment of mediastinitis: early modified Robicsek closure and pectoralis major advancement flaps. Ann Thorac Surg 65: 41–6
Catarino PA, Chamberlain MH, Wright NC, et al. (2000) High pressure suction drainage via a polyurethane foam in the management of posternotomy mediastinitis. Ann Thorac Surg 70: 1891–5
Cowan KN, Teague L, Sue SC, Mahoney JL (2005) Vacuum-assisted wound closure of deep sternal infections in high-risk patients after cardiac surgery. Ann Thorac Surg 80: 2205–12
Fleck TM, Fleck M, Moidl R, et al. (2002) The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg 74: 1567–600
Domkowski PW, Smith ML, Gonyon D, et al. (2003) Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis. J Thorac Cardiovasc Surg 126: 386–390
Sjogren J, Gustafsson R, Nilsson J, et al. (2005) Clinical outcome after poststernotomy mediastinitis: vacuum-assisted closure versus conventional treatment. Ann Thorac Surg 79: 2049–55
Guedon C (2003) Rôle de la chirurgie plastique dans la prise en charge des médiastinites aiguës de l’adulte. Ann Chir Plast Esthet 48: 115–27
Milano C, Georgiade G, Muhlbaier L, et al. (1999) Comparison of omental and pectoralis flaps for poststernotomy mediastinitis. Ann thorac Surg 67: 377–81
Beiras-Fernandez A, Kur F, Kiefer S, et al. (2009) Multidrug-resistant gram-positive infections in patients with ventricular assist devices: the role of daptomycin. Transplant Proc 41: 2589–91
Atkins BZ, Onaitis MW, Hutcheson KA, et al. (2011) Does method of sternal repair influence long-term outcome of postoperative mediastinitis? Am J Surg 202: 565–7
Lepelletier D, Poupelin L, Corvec S, et al. (2009) Risk factors for mortality in patients with mediastinitis after cardiac surgery. Arch Cardiovasc Dis 102: 119–25
Francel TJ, Kouchoukos NT (2001) A rational approach to wound difficulties after sternotomy: reconstruction and long-term results. Ann Thorac Surg 72: 1419–29
Combes A, Trouillet JL, Baudot J, et al. (2001) Is it possible to cure mediastinitis in patients with major postcardiac surgery complications? Ann Thorac Surg 72: 1592–7
Yellin A, Refaely Y, Paley M, Simansky D (2003) Major bleeding complicating deep sternal infection after cardiac surgery. J Thorac Cardiovasc Surg 125: 554–8
Petzina R, Malmsjö M, Stamm C, Hetzer R (2010) Major complications during negative pressure wound therapy in posternotomy mediastinitis after cardiac surgery. J Thorac Cardiovasc Surg 140: 1133–6
Mekontso-Dessap A, Vivier E, Girou E, et al. (2010) Effect of time to onset on clinical features and prognosis of post-srenotomy mediastinitis. Clin Microbiol Infect 17: 292–9
Mekontso-Dessap A, Kirsch M, Brun-Buisson C, Loisance D (2001) Poststernotomy mediastinitis due to Staphylococcus aureus: comparison of methicillin-resistant. and methicillin-susceptible cases. Clin Infect Dis 32: 877–83
Combes A, Trouillet JL, Joly-Guillou ML, et al. (2004) The impact of methicillin resistance on the outcome of poststernotomy mediastinitis due to Stapylococcus aureus. Clin Infect Dis 38: 822–9
Lucet JC, Batisse D, Brücker G (1997) Médiastinites après sternototomie. Mortalité et durée de séjour. Groupe parisien d’étude des sternotomies. Arch Mal Cœur Vaiss 90: 471–5
Kappstein I, Schulgen G, Fraedrich G, et al. (1992) Added hospital stay due to wound infections following cardiac surgery. Thorac Cardiovasc Surg 40: 148–51
Hollenbeak CS, Murphy DM, Koenigg S, et al. (2000) The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 118: 397–402
Braxton JH, Marrin CA, McGrath PD, et al. (2000) Mediastinitis and long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg 70: 2004–7
Surveiller et prévenir les infections associées aux soins (2010) Hygiènes 18: 3–165
Paul M, Raz A, Leibovici L, et al. (2007) Sternal wound infection after coronary artery bypass graft surgery: validation of existing risk scores. J Thorac Cardiovasc Surg 133: 397–403
Bode LG, Kluytmans JA, Wertheim HF, et al. (2010) Preventing surgical site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362: 9–17
Segers P, Speekenbrink HR, Ubink DT, et al. (2006) Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx by chlorhexidine gluconate. A randomized controlled trial. JAMA
(2011) Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes). Actualisation 2010. Ann Fr Anesth Reanim 168–190
Mertz D, Johnstone J, Loeb M (2011) Does duration of perioperative antibiotic prophylaxis matter in cardiac surgery? A systematic review and meta-analysis. Ann Surg 254: 48–54
LadorA, Nasir H, Mansur N, et al. (2012) Antibiotic prophylaxis in cardiac surgery: systematic review and meta-analysis. J Antimicrob Chemother 67: 541–50
Bennett-Guerrero E, Ferguson TB, Lin M, et al. (2010) Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery. JAMA 304: 755–62
Schimmer C, Özkur M, Sinha B, et al. (2012) Gentamicin-collagen sponge reduces sternal wound complications after heart surgery: A controlled, prospectively randomized, double-blind study 143: 194–200
Furnary AP, Zerr KJ, Grunkemeier GL, Starr A (1999) Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedure. Ann Thorac Surg 67: 352–63
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Trouillet, JL. (2013). Infections postopératoires : médiastinites. In: Infectiologie en réanimation. Références en réanimation. Collection de la SRLF. Springer, Paris. https://doi.org/10.1007/978-2-8178-0389-0_20
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