Post-cardiac surgery fungal mediastinitis: clinical features, pathogens and outcome
Geoffroy Hariri,
Mathieu Genoud,
Vincent Bruckert,
Samuel Chosidow,
Emmanuel Guérot,
Antoine Kimmoun,
Nicolas Nesseler,
Emmanuel Besnier,
Fabrice Daviaud,
David Lagier,
Julien Imbault,
David Grimaldi,
Adrien Bouglé,
Nicolas Mongardon
Affiliations
Geoffroy Hariri
Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université
Mathieu Genoud
Service des urgences, Département de médecine aiguë, Hôpitaux Universitaires de Genève
Vincent Bruckert
Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université
Samuel Chosidow
Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor
Emmanuel Guérot
Médecine intensive-réanimation, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP)
Antoine Kimmoun
CHRU de Nancy, Médecine intensive-réanimation Brabois, Inserm U1116, Université de Lorraine
Nicolas Nesseler
Service d’anesthésie-réanimation, CHU de Rennes
Emmanuel Besnier
Département d’anesthésie-réanimation, CHU de Rouen
Fabrice Daviaud
Service de réanimation, Centre Cardiologique du Nord
David Lagier
Service d’anesthésie réanimation 1, CHU la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM)
Julien Imbault
Service d’anesthésie réanimation sud, centre médico-chirurgical Magellan, CHU de Bordeaux
David Grimaldi
Service de réanimation polyvalente, Hôpital Erasme, cliniques universitaires de Bruxelles
Adrien Bouglé
Département d’anesthésie et réanimation, Institut de Cardiologie, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU DREAM, Hôpital La Pitié-Salpêtrière, Sorbonne Université
Nicolas Mongardon
Service d’anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor
Abstract Objectives 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. Methods Multicenter retrospective study among 10 intensive care units (ICU) in France and Belgium of proven cases of fungal mediastinitis after cardiac surgery (2009–2019). Results 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/m2; p = 0.028) and lower Simplified Acute Physiology Score II score at ICU admission (37 [28–40] vs. 54 [34–61]; p = 0.012). Conclusion 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.
