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Lemmet T, Mazzucotelli JP, Collange O, Fath L, Mutter D, Brigand C, Falcoz PE, Danion F, Lefebvre N, Bourne-Watrin M, Gerber V, Hoellinger B, Fabacher T, Hansmann Y, Ruch Y. Infectious Mediastinitis: A Retrospective Cohort Study. Open Forum Infect Dis 2024; 11:ofae225. [PMID: 38751899 PMCID: PMC11095524 DOI: 10.1093/ofid/ofae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Background This study aimed to characterize the demographics, microbiology, management and treatment outcomes of mediastinitis according to the origin of the infection. Methods This retrospective observational study enrolled patients who had mediastinitis diagnosed according to the criteria defined by the Centers for Disease Control and Prevention and were treated in Strasbourg University Hospital, France, between 1 January 2010 and 31 December 2020. Results We investigated 151 cases, including 63 cases of poststernotomy mediastinitis (PSM), 60 cases of mediastinitis due to esophageal perforation (MEP) and 17 cases of descending necrotizing mediastinitis (DNM). The mean patient age (standard deviation) was 63 (14.5) years, and 109 of 151 patients were male. Microbiological documentation varied according to the origin of the infection. When documented, PSM cases were mostly monomicrobial (36 of 53 cases [67.9%]) and involved staphylococci (36 of 53 [67.9%]), whereas MEP and DNM cases were mostly plurimicrobial (38 of 48 [79.2%] and 8 of 12 [66.7%], respectively) and involved digestive or oral flora microorganisms, respectively. The median duration of anti-infective treatment was 41 days (interquartile range, 21-56 days), and 122 of 151 patients (80.8%) benefited from early surgical management. The overall 1-year survival rate was estimated to be 64.8% (95% confidence interval, 56.6%-74.3%), but varied from 80.1% for DNM to 61.5% for MEP. Conclusions Mediastinitis represents a rare yet deadly infection. The present cohort study exhibited the different patterns observed according to the origin of the infection. Greater insight and knowledge on these differences may help guide the management of these complex infections, especially with respect to empirical anti-infective treatments.
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Affiliation(s)
- Thomas Lemmet
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | | | - Olivier Collange
- Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France
| | - Léa Fath
- Department of E.N.T. and Head and Neck Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Didier Mutter
- Department of Visceral and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - François Danion
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Bourne-Watrin
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Victor Gerber
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Baptiste Hoellinger
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Thibaut Fabacher
- Department of biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Yvon Ruch
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
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Méchaï F, Kolakowska A, Carbonnelle E, Bouchaud O, Tresallet C, Jaureguy F. Intra-abdominal abscesses: Microbiological epidemiology and empirical antibiotherapy. Infect Dis Now 2023; 53:104604. [PMID: 36067948 DOI: 10.1016/j.idnow.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/29/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Data on the microbiological epidemiology of Intra-Abdominal Abscesses (IAAs) are very scarce. We aimed to study the microbiological epidemiology of these infections in order to optimize empirical antibiotic therapy. PATIENTS AND METHODS Between January 2015 and December 2020, we retrospectively analyzed all IAAs files in our hospital. Clinical and microbiological data such as antibiotic susceptibilities were collected. RESULTS We studied 243 IAA cases. All in all, 139 (57.2%) IAAs were healthcare-associated and 201 (82.7%) were drained. The highest risk situations for IAAs were appendicitis (n = 69) and diverticulitis (n = 37). Out of the 163 microbiologically documented infections, 136 (81.9%) were polymicrobial. Enterobacterales (n = 192, 36.1%), Enterococcus sp. (n = 84, 17.6%) and anaerobes (n = 66, 16.1%) were the most frequently identified bacteria. Gram-negative bacteria were susceptible to amoxicillin-acid clavulanic, piperacillin-tazobactam, cefotaxime, meropenem in 55.2%, 84.9%, 77.6% and 99.5% of cases, respectively. Concerning Gram-positive bacteria, the susceptibility rate was 81.8% for amoxicillin-clavulanic acid, piperacillin-tazobactam and meropenem, and decreased to 63.4% for cefotaxime. CONCLUSION This study highlights the polymicrobial profile of IAAs and their low susceptibility to amoxicillin and clavulanic acid. The piperacillin-tazobactam association remained the most appropriate empirical antibiotic therapy.
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Affiliation(s)
- F Méchaï
- Infectious Disease Department, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France; IAME, INSERM UMR 1137, Université Sorbonne Paris Nord, Sorbonne Paris Cité, France.
| | - A Kolakowska
- Infectious Disease Department, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - E Carbonnelle
- IAME, INSERM UMR 1137, Université Sorbonne Paris Nord, Sorbonne Paris Cité, France; Clinical Microbiology Department, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - O Bouchaud
- Infectious Disease Department, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - C Tresallet
- Visceral Surgery Department, Avicenne Hospital, Bobigny, France
| | - F Jaureguy
- IAME, INSERM UMR 1137, Université Sorbonne Paris Nord, Sorbonne Paris Cité, France; Clinical Microbiology Department, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
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Phylogeny of Catabacter hongkongensis Strains Responsible for Bacteremia Is Not Associated with Clinical Outcomes or Therapeutic Efficacy. Diseases 2021; 9:diseases9020024. [PMID: 33805909 PMCID: PMC8103246 DOI: 10.3390/diseases9020024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
Catabacter hongkongensis is a Gram-positive rod, isolated in 2007 in blood culture. Fewer than 15 infections have been reported. Herein, we present a lethal case of bacteremia due to C. hongkongensis identified through phylogenetic analyses. A woman was found unconscious in a context of chronic diarrhea. An abdominal abscess with a hydroaeric level was discovered, associated with sigmoid adenocarcinoma and peritoneal carcinomatosis. Despite hospitalization in an ICU and the adaptation of antibiotic therapy, the patient died. Blood cultures were positive in the final stage of the disease (>60 h). Identification of C. hongkongensis was performed using 16S rDNA sequencing. Phylogenetic analyses did not enable classification of these strains according to clinical outcome or the antibiotic sensitivity to treatment. In this case, bacteria were difficult to isolate and MALDI-TOF remained non-contributive. As strains are resistant to probabilistic treatments, addition of metronidazole or vancomycin could optimize clinical management, highlighting the benefit of rapid molecular identification by sequencing.
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Wang Y, McGuire TM, Hollingworth SA, Dong Y, Van Driel ML. Antifungal agents for invasive candidiasis in non-neutropenic critically ill adults: What do the guidelines recommend? Int J Infect Dis 2019; 89:137-145. [PMID: 31639522 DOI: 10.1016/j.ijid.2019.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Recommendations in clinical practice guidelines (CPG) may differ and cause confusion. Our objective was to appraise CPGs for antifungal treatment of invasive candidiasis (IC) in non-neutropenic critically ill adult patients. METHODS We systematically searched the literature for CPGs published between 2008 and 2018. We assessed the quality of each guideline using six domains of the AGREE II instrument. We extracted and compared recommendations for different treatment strategies and assessed content quality. RESULTS Of 19 guidelines, the mean overall AGREE II score was 58%. The domain 'clarity of presentation' received the highest scores (88%) and 'applicability' the lowest (18%). CPGs provided detailed recommendations on antifungal prophylaxis (n = 10), with fluconazole recommended as initial prophylaxis in all seven CPGs citing a specific drug. Echinocandin was recommended as the initial drug in all 16 CPGs supporting empirical/pre-emptive treatment; and in 18 of 19 for targeted invasive candidiasis treatment. However, it remains unclear when to initiate prophylaxis, empirical or pre-emptive therapy or when to step down. CONCLUSIONS The methodological quality of CPGs for antifungal treatment of IC in non-neutropenic critically ill patients is suboptimal. Some treatment recommendations were inconsistent across indications and require local guidance to help clinicians make better informed decisions.
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Affiliation(s)
- Yan Wang
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia.
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia; Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia; Mater Pharmacy, Mater Health, Brisbane, Queensland, Australia.
| | | | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Mieke L Van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
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