Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Department of Anaesthesiology and Intensive Care Medicine, Marseille, France.
MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France.
Clin Microbiol Infect. 2020 Jan;26(1):26-34. doi: 10.1016/j.cmi.2019.07.005. Epub 2019 Jul 12.
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.
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.
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.
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.
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.
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。由于其靠近重要结构，纵隔炎代表了一种高度病态的病理过程，与高死亡率相关。在大多数情况下，纵隔炎需要在重症监护病房治疗。
向读者强调纵隔炎的临床特征，尝试定义每种临床情况，描述致病病原体，最后描述医学和手术治疗。
我们对 PubMed 和 Cochrane 图书馆进行了文献检索，检索时间限制为 2003 年 1 月至 2018 年 12 月之间发表的报告急性纵隔炎的文章。
该术语涵盖了不同病因的不同实体，包括与开胸术相关的深部胸骨伤口感染；食管穿孔或吻合口漏；最后是下行坏死性纵隔炎，通常继发于咽脓肿。致病病原体和随后的治疗取决于潜在的病因。经验性抗菌治疗应覆盖可疑的微生物，而手术和支持措施应通过提供充分的引流和清创来减少病原体的接种量。
关于重症监护病房纵隔炎的文献相对较少。我们收集了证据，并回顾了急性纵隔炎的不同原因和治疗选择，特别关注微生物流行病学。需要在更大的队列中进行未来的研究，以更好地了解这种难治性疾病的治疗方法。
