BACKGROUND Mediastinitis is a rare but severe infection, defined as an inflammation of the connective tissues and structures within the mediastinum. Due to its proximity to vital structures, mediastinitis represents a highly morbid pathological process associated with a high risk of mortality. In most cases mediastinitis requires treatment in the intensive care unit. OBJECTIVES To highlight to the reader the clinical features of mediastinitis, to attempt to define each clinical scenario, to describe the responsible pathogens and finally to depict both the medical and surgical treatments. SOURCES We performed a literature search of the PubMed and Cochrane libraries, limited for articles published between January 2003 and December 2018, reporting on acute mediastinitis. CONTENT The term covers different entities of different aetiologies including deep sternal wound infection related to sternotomy; oesophageal perforation or anastomosis leakage; and finally descending necrotizing mediastinitis, often secondary to oropharyngeal abscess. The responsible pathogens and therefore subsequent management depends on the underlying aetiology. Empirical antimicrobial therapy should cover the suspected microorganisms while surgery and supportive measures should aim to reduce the inoculum of pathogens by providing adequate drainage and debridement. IMPLICATIONS Literature concerning mediastinitis in the intensive care unit is relatively scarce. We have collated the evidence and reviewed the different causes and treatment options of acute mediastinitis with a particular focus on microbiological epidemiology. Future research in larger cohorts is needed to better understand the treatment of this difficult disease.

中文翻译：

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重症监护病房纵隔炎：叙事回顾。

背景技术纵隔炎是一种罕见但严重的感染，定义为纵隔内结缔组织和结构的炎症。由于其邻近重要结构，纵隔炎是一种高度致病的病理过程，具有很高的死亡风险。在大多数情况下，纵隔炎需要在重症监护室进行治疗。目的向读者强调纵隔炎的临床特征，试图定义每种临床情况，描述负责任的病原体，最后描述医学和外科治疗。资料来源我们对PubMed和Cochrane库进行了文献检索，仅限于2003年1月至2018年12月之间发表的报道急性纵隔炎的文章。内容该术语涵盖了不同病因的不同实体，包括与胸骨切开术相关的深胸骨伤口感染；食道穿孔或吻合口漏；最后下降的坏死性纵隔炎，通常继发于口咽脓肿。负责任的病原体以及因此的后续管理取决于潜在的病因。经验性抗菌治疗应涵盖可疑微生物，而手术和支持措施应旨在通过提供足够的引流和清创术来减少病原体的接种量。后果有关重症监护病房纵隔炎的文献相对较少。我们已经收集了证据，并回顾了急性纵隔炎的不同原因和治疗选择，特别关注了微生物流行病学。