Wang Fang, Zhan Qing, Yu Anfeng, Chen Hongchao, Zhang Yan, Yang Qing, Qu Tingting
Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.
Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.
Heliyon. 2024 Oct 24;10(22):e39763. doi: 10.1016/j.heliyon.2024.e39763. eCollection 2024 Nov 30.
, a commensal organism, is potentially pathogenic; its role in postoperative infections might be underestimated in cardiac surgery.
We reported two cases of postoperative mediastinitis in immunocompetent patients with a DeBakey grade I aortic dissecting aneurysm and reviewed 10 other cases previously described. Among the 10 reviewed cases and our two cases, 11 patients were men (median age, 59 years; median onset of clinical symptoms time, 14.5 d after surgery; and mean peak of temperature, 38.5 ± 0.8 °C). In our reports, two patients underwent sternotomy site reopening and debridement before diagnosis was confirmed. Diagnosis was confirmed by prolonged culture and by performing metagenomic next-generation sequencing directly using the clinical samples. was difficult to cover with initial empirical antibiotic therapy; the patient in this study showed complete improvement with long-term antimicrobial therapy. The targeted treatment duration for surviving patients among the reviewed cases ranged from three weeks to 16 months.
The diagnosis of extragenital infections is difficult. Therefore, the role of as a cause of postoperative infections during cardiac surgery should be considered. Diagnosis requires molecular techniques to complement culture.
作为一种共生生物，具有潜在致病性；其在心脏手术术后感染中的作用可能被低估。
我们报告了2例患有DeBakey I型主动脉夹层动脉瘤的免疫功能正常患者发生术后纵隔炎的病例，并回顾了之前描述的其他10例病例。在回顾的10例病例和我们的2例病例中，11例患者为男性（中位年龄59岁；临床症状出现的中位时间为术后14.5天；平均体温峰值为38.5±0.8°C）。在我们的报告中，2例患者在确诊前接受了胸骨切开部位重新切开和清创术。通过延长培养以及直接使用临床样本进行宏基因组下一代测序来确诊。初始经验性抗生素治疗难以覆盖；本研究中的患者通过长期抗菌治疗显示完全康复。回顾病例中存活患者的靶向治疗持续时间为3周至16个月。
生殖器外感染的诊断困难。因此，应考虑在心脏手术期间作为术后感染原因的作用。诊断需要分子技术来补充培养。
