Is it possible to cure mediastinitis in patients with major postcardiac surgery complications?

Background. The prognosis for mediastinitis after cardiac operation has imp roved during the last two decades, but most series do not include patients who already have a major postoperative complication when the infection deve loped. Methods. Our 9-year prospective study of 371 consecutive patients with medi astinitis compared the characteristics of patients admitted to the intensiv e care unit primarily for mediastinitis with those who developed mediastini tis after intensive care unit admission for severe postoperative organ fail ure. Results. We identified 323 (87%) primary and 48 (13%) secondary mediastinit is patients. The incubation time for mediastinitis was longer for secondary mediastinitis patients, despite similar initial operations. Staphylococcus aureus was responsible for approximately 60% of the episodes in both group s; however, the incidence of methicillin resistance was 2.5 times higher in secondary mediastinitis patients (p < 0.0001). The mediastinitis cure rate was similar for both groups. However, intensive care unit mortality (63% v ersus 21%), duration of mechanical ventilation (40 versus 9 days), and leng th of intensive care unit stay (53 versus 28 days) were significantly highe r for secondary mediastinitis patients (p < 0.0001). Conclusions. The presence of a prior major postoperative complication does not alter the cure rate of mediastinal infections, but does greatly reduce the survival rate. (C) 2001 by The Society of Thoracic Surgeons.