Cunningham Cody A, Grys Thomas E, Downey Francis X, Saling Christopher F, Orenstein Robert, Blair Janis E
Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Scottsdale, Arizona, USA.
Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Open Forum Infect Dis. 2024 May 28;11(6):ofae302. doi: 10.1093/ofid/ofae302. eCollection 2024 Jun.
Deep sternal wound infection is a rare complication of cardiac surgery that is typically caused by skin resident flora, such as species of and . Infections caused by fungi are less common and are generally caused by species. Regardless of etiology, these infections are associated with significant morbidity and mortality. We present a case of postoperative mediastinitis that occurred following a 5-vessel coronary artery bypass graft and was caused by a filamentous fungus of the genus. The patient was treated with serial debridement, liposomal amphotericin B, and isavuconazonium and was discharged from the hospital in stable condition. Fungal mediastinitis is a rare entity, and clinicians must maintain a high level of suspicion to make the diagnosis. A fungal cause of postoperative mediastinitis should be considered in patients with negative bacterial cultures, uncontrolled diabetes, or current immunosuppression or those who present weeks after surgery with a subacute onset of symptoms.
深部胸骨伤口感染是心脏手术中一种罕见的并发症,通常由皮肤常驻菌群引起,如 属和 属的菌种。真菌引起的感染较少见,一般由 属菌种引起。无论病因如何,这些感染都与显著的发病率和死亡率相关。我们报告一例在5支血管冠状动脉搭桥术后发生的纵隔炎病例,由 属丝状真菌引起。患者接受了多次清创、脂质体两性霉素B和艾沙康唑治疗,出院时病情稳定。真菌性纵隔炎是一种罕见疾病,临床医生必须保持高度怀疑以做出诊断。对于细菌培养阴性、糖尿病控制不佳、当前存在免疫抑制的患者,或术后数周出现亚急性症状的患者,应考虑术后纵隔炎的真菌病因。