A comparative study of the rare but deadly infection: Post-sternotomy mediastinitis and descending necrotizing mediastinitis with an analysis of outcome-determining factors

Abstract

Aim Mediastinitis, a rare yet serious infection, affects the mediastinum. This study aims to compare the demographic, clinical, and laboratory characteristics of patients diagnosed with post-sternotomy mediastinitis (PSM) or descending necrotizing mediastinitis (DNM) to identify features of non-surviving patients. Materıal and Methods This study included patients diagnosed with PSM and DNM between 2015 and 2022 at the Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital. Patients were categorized and compared as survivors and non-survivors. Results This study included 25 patients diagnosed with mediastinitis. The average age was 54.9 ± 12.1, with 64% being male. Blood cultures were obtained from 92% of patients. Purulent discharge cultures were sent for 88% of patients, with 44% showing growth. Comorbidities were present in 84% and the prevalence of comorbidities, sepsis, and ICU hospitalization after diagnosis was significantly higher in PSM patients (p=0.017, p=0.004, p=0.026). Heart failure, coronary artery disease, and hypertension were significantly higher in PSM patients (ps=0.000). PSM patients were also significantly more common in the non-survivor group (p=0.012). The non-survivor group had higher average age, more smokers, and longer intensive care unit stays post-diagnosis (p=0.046, p=0.049, p=0.038). Patients with PSM, HT, and CAD were significantly more common in the non-survivor group (p=0.012, p=0.008, p=0.033). Conclusion Mediastinitis is a rare but serious condition with high mortality and morbidity rates. In patients with a higher risk of mortality, such as the elderly, smokers, patients with median sternotomy, and those with comorbidities, treatment and follow-up strategies can be improved.