Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome

• Published in: Critical care (London, England) Vol. 27; no. 1; p. 6
• Main Authors: Hariri, Geoffroy, Genoud, Mathieu, Bruckert, Vincent, Chosidow, Samuel, Guérot, Emmanuel, Kimmoun, Antoine, Nesseler, Nicolas, Besnier, Emmanuel, Daviaud, Fabrice, Lagier, David, Imbault, Julien, Grimaldi, David, Bouglé, Adrien, Mongardon, Nicolas
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.01.2023; BioMed Central; BMC
• Subjects: Antifungal agents; Belgium; Candida; Cardiac surgery; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Care and treatment; Critically ill; Dosage and administration; Fungus; Healthcare-associated infection; Heart; Humans; Life Sciences; Mediastinitis; Mediastinitis - epidemiology; Mediastinitis - microbiology; Nosocomial infection; Prevention; Retrospective Studies; Risk factors; Surgical wound infections; Transplantation; Belgium; France; Aspergillus; Fungus; Nosocomial infection; Healthcare-associated infection; Candida; Mediastinitis; Cardiac surgery; Trichosporon
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/s13054-022-04277-6

The occurrence of mediastinitis after cardiac surgery remains a rare and severe complication associated with poor outcomes. Whereas bacterial mediastinitis have been largely described, little is known about their fungal etiologies. We report incidence, characteristics and outcome of post-cardiac surgery fungal mediastinitis. Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009-2019). Among 73,688 cardiac surgery procedures, 40 patients developed fungal mediastinitis. Five were supported with left ventricular assist device and five with veno-arterial extracorporeal membrane oxygenation before initial surgery. Twelve patients received prior heart transplantation. Interval between initial surgery and mediastinitis was 38 [17-61] days. Only half of the patients showed local signs of infection. Septic shock was uncommon at diagnosis (12.5%). Forty-three fungal strains were identified: Candida spp. (34 patients), Trichosporon spp. (5 patients) and Aspergillus spp. (4 patients). Hospital mortality was 58%. Survivors were younger (59 [43-65] vs. 65 [61-73] yo; p = 0.013), had lower body mass index (24 [20-26] vs. 30 [24-32] kg/m ; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28-40] vs. 54 [34-61]; p = 0.012). Fungal mediastinitis is a very rare complication after cardiac surgery, associated with a high mortality rate. This entity should be suspected in patients with a smoldering infectious postoperative course, especially those supported with short- or long-term invasive cardiac support devices, or following heart transplantation.