Abstract

OBJECTIVES

Postoperative mediastinitis, a feared complication after cardiac surgery, is associated with high mortality, especially of critically ill patients. Candida species infections are rare and severe, with poorly known outcomes. We conducted a case–control study to describe the characteristics, management and outcomes of patients with postoperative Candida mediastinitis.

METHODS

This French, monocentre, retrospective study included all patients with postoperative Candida mediastinitis (January 2003–February 2020) requiring intensive care unit admission. Candida mediastinitis patients (henceforth cases) were matched 1:1 with postoperative bacterial mediastinitis (henceforth control), based on 3 factors during mediastinitis management: age >40 years, cardiac transplantation and invasive circulatory device used. The primary end point was the probability of survival within 1 year after intensive care unit (ICU) admission.

RESULTS

Forty cases were matched to 40 controls. The global male/female ratio was 2.1, with mean age at admission 47.9 ± 13.8 years. Candida species were: 67.5% albicans, 17.5% glabrata, 15% parapsilosis, 5.0% tropicalis, 2.5% krusei and 2.5% lusitaniae. The median duration of mechanical ventilation was 23, 68.8% of patients received renal replacement therapy and 62.5% extracorporeal membrane oxygenation support. The probability of survival within the first year after ICU admission was 40 ± 5.5% and was significantly lower for cases than for controls (43 ± 8% vs 80 ± 6.3%, respectively; Log-rank test: P < 0.0001). The multivariable Cox proportional hazards model retained only renal replacement therapy [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.1–13.1; P = 0.04] and Candida mediastinitis (HR 2.4, 95% CI 1.1–5.6; P = 0.04) as independently associated with 1-year mortality.

CONCLUSIONS

Candida mediastinitis is a serious event after cardiac surgery and independently associated with 1-year mortality. Further studies are needed to determine whether deaths are directly attributable to Candida mediastinitis.

中文翻译：

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术后念珠菌与细菌性纵隔炎患者的特征和结果：病例匹配比较研究

摘要

目标

术后纵隔炎是心脏手术后令人担忧的并发症，与高死亡率相关，尤其是危重患者。念珠菌属感染罕见且严重，结果鲜为人知。我们进行了一项病例对照研究，以描述术后念珠菌性纵隔炎患者的特征、管理和结果。

方法

这项法国、单中心、回顾性研究包括所有需要重症监护病房入院的术后念珠菌纵隔炎患者（2003 年 1 月至 2020 年 2 月）。根据纵隔炎治疗期间的 3 个因素：年龄 > 40 岁、心脏移植和使用的侵入性循环装置，念珠菌纵隔炎患者（以下称为病例）与术后细菌性纵隔炎（以下称为对照）按 1:1 匹配。主要终点是重症监护病房 (ICU) 入院后 1 年内的生存概率。

结果

40 个病例与 40 个对照匹配。全球男女比例为 2.1，入院时平均年龄为 47.9 ± 13.8 岁。念珠菌种类为：67.5% 的白色念珠菌、17.5%的光滑念珠菌、15%的近平滑念珠菌、5.0%的热带念珠菌、2.5% 的克氏念珠菌和 2.5%的卢西塔尼亚念珠菌。机械通气的中位持续时间为 23 天，68.8% 的患者接受了肾脏替代治疗和 62.5% 的体外膜肺氧合支持。入住 ICU 后第一年内的生存概率为 40 ± 5.5%，且病例显着低于对照组（分别为 43 ± 8% 和 80 ± 6.3%；对数秩检验：P< 0.0001)。多变量 Cox 比例风险模型仅保留肾脏替代治疗 [风险比 (HR) 3.7, 95% 置信区间 (CI) 1.1-13.1；P = 0.04] 和念珠菌纵隔炎 (HR 2.4, 95% CI 1.1–5.6; P = 0.04) 与 1 年死亡率独立相关。

结论

念珠菌纵隔炎是心脏手术后的严重事件，与 1 年死亡率独立相关。需要进一步的研究来确定死亡是否直接归因于念珠菌纵隔炎。