Introduction

Mediastinitis is an infrequent but serious complication of cardiac surgery. Antimicrobial treatment guidelines are not well established. The aim was to describe the efficacy of sequential intravenous to oral therapy in selected post-surgical mediastinitis patients.

Methods

A retrospective observational study including cases of mediastinitis after cardiac surgery, defined according to CDC criteria, at a third-level university hospital between January 2002 and December 2016. Sequential antimicrobial therapy was proposed in clinically stable patients. Rates of cure, relapse, and hospital stay were compared between patients who received sequential intravenous to oral therapy and those who received therapy exclusively by the intravenous route.

Results

Eighty-one cases were included. Sequential intravenous to oral therapy was performed in 48 (59.3%) patients on median day 15. No differences in baseline characteristics or causal microorganisms were found between the two cohorts. The average duration of antibiotic therapy was 41.2 ± 10.09 days. The most commonly used drugs in sequential therapy were quinolones in 31 (64.6%) cases and rifampicin, always in association with another antibiotic, in 25 (52.1%). Hospital stay was shorter in the sequential therapy group (57.57 ± 34.03 vs. 84.35 ± 45.67; P = 0.007). Cure was achieved in 77 (92.8%) patients. Overall in-hospital mortality was less frequent in the group that received sequential therapy (2.1% vs. 15.2%; P = 0.039). There were no differences in relapse between the two cohorts (4.2% vs 9.1%; P = 0.366).

Conclusion

Sequential antimicrobial treatment in selected patients with post-surgical mediastinitis may be as effective as exclusively intravenous treatment, reducing risks, hospital stay and associated costs.

中文翻译：

---

心脏手术后纵隔炎的序贯抗菌治疗：81例观察性研究。

介绍

纵隔炎是一种罕见但严重的心脏手术并发症。抗菌药物治疗指南尚未完善。目的是描述在选定的手术后纵隔炎患者中连续静脉内至口服治疗的疗效。

方法

一项回顾性观察研究，包括 2002 年 1 月至 2016 年 12 月在三级大学医院心脏手术后纵隔炎病例，根据 CDC 标准定义。建议对临床稳定的患者进行序贯抗菌治疗。比较接受连续静脉给药和口服治疗的患者与仅接受静脉途径治疗的患者的治愈率、复发率和住院时间。

结果

包括八十一个案例。在中位第 15 天对 48 名（59.3%）患者进行了静脉到口服的序贯治疗。在两个队列之间没有发现基线特征或致病微生物的差异。抗生素治疗的平均持续时间为 41.2 ± 10.09 天。序贯治疗中最常用的药物是喹诺酮类药物（31 例（64.6%））和利福平，25 例（52.1%）总是与另一种抗生素联合使用。序贯治疗组的住院时间较短（57.57 ± 34.03 vs. 84.35 ± 45.67；P  = 0.007）。77 名 (92.8%) 患者治愈。接受序贯治疗组的总体院内死亡率较低（2.1% vs. 15.2%；P = 0.039）。两组之间的复发率没有差异（4.2% 对 9.1%；P  = 0.366）。

结论

对选定的手术后纵隔炎患者进行序贯抗菌治疗可能与单纯静脉治疗一样有效，可降低风险、住院时间和相关费用。