ABSTRACT
La mediastinitis se define como la inflamación aguda o crónica de las estructuras mediastínicas. Se presenta con una baja incidencia en general. La causa aguda más frecuente es la postesternotomía derivada de la cirugía cardíaca de revascularización con ambas arterias mamarias internas, con una incidencia del 0,4-5% y una mortalidad del 16,5 al 47%, siendo el vector más frecuente el Staphylococcus aureus. La perforación esofágica normalmente iatrogénica es la segunda causa de mediastinitis aguda, vehiculizada por flora orofaríngea común, con una mortalidad del 20 al 60%, dependiendo del momento del diagnóstico. La mediastinitis necrotizante descendente es la tercera causa, siendo el foco odontógeno en un 60% el origen y el Streptococcus β-hemolítico el microorganismo causante en el 71,5%. La tomografía computarizada es la herramienta diagnóstica de imagen más adecuada. El tratamiento es prácticamente siempre quirúrgico y su precocidad determina la supervivencia de estos pacientes. El choque séptico es el factor de peor pronóstico posquirúrgico (AU)
Mediastinitis is defined as acute or chronic inflammation of the mediastinal structures and generally has a low incidence. The most frequent acute cause is sternotomy following cardiac revascularization surgery with both internal mammary arteries, with an incidence of 0.4% to 5% and a mortality of 16.5% to 47 %. The most frequent vector is Staphylococcus aureus. Esophageal perforation, usually iatrogenic, is the second most frequent cause of acute mediastinitis, produced by common oropharyngeal flora, with a mortality rate of 20% to 60%, depending on the time of diagnosis. The third most frequent cause is descending necrotizing mediastinitis, the origin being an odontogenous focus in 60% and beta-hemolytic streptococcus the causative agent in 71.5 % of cases. The most accurate diagnostic imaging technique is computed tomography. Treatment is almost always surgical and survival depends on its early performance. The worst postsurgical prognostic factor is septic shock (AU)
Subject(s)
Humans , Mediastinitis/drug therapy , Mediastinitis/epidemiology , Mediastinitis/etiology , Mediastinitis/microbiology , Mediastinitis/surgery , Mouth/microbiology , Shock, Septic/etiology , Shock, Septic/mortality , Sternotomy , Surgical Wound Infection , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Debridement , Drainage , Esophageal Perforation/complications , Esophageal Perforation/microbiology , Internal Mammary-Coronary Artery Anastomosis , Mediastinal Emphysema/etiology , Prognosis , Retropharyngeal Abscess , Staphylococcal Infections , Streptococcal InfectionsABSTRACT
Mediastinitis is defined as acute or chronic inflammation of the mediastinal structures and generally has a low incidence. The most frequent acute cause is sternotomy following cardiac revascularization surgery with both internal mammary arteries, with an incidence of 0.4% to 5% and a mortality of 16.5% to 47%. The most frequent vector is Staphylococcus aureus. Esophageal perforation, usually iatrogenic, is the second most frequent cause of acute mediastinitis, produced by common oropharyngeal flora, with a mortality rate of 20% to 60%, depending on the time of diagnosis. The third most frequent cause is descending necrotizing mediastinitis, the origin being an odontogenous focus in 60% and beta-hemolytic streptococcus the causative agent in 71.5% of cases. The most accurate diagnostic imaging technique is computed tomography. Treatment is almost always surgical and survival depends on its early performance. The worst postsurgical prognostic factor is septic shock.
Subject(s)
Mediastinitis , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Debridement , Drainage , Esophageal Perforation/complications , Esophageal Perforation/microbiology , Humans , Internal Mammary-Coronary Artery Anastomosis , Mediastinal Emphysema/etiology , Mediastinitis/drug therapy , Mediastinitis/epidemiology , Mediastinitis/etiology , Mediastinitis/microbiology , Mediastinitis/surgery , Mouth/microbiology , Prognosis , Retropharyngeal Abscess/complications , Shock, Septic/etiology , Shock, Septic/mortality , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Infections/etiology , Staphylococcal Infections/surgery , Sternotomy , Streptococcal Infections/drug therapy , Streptococcal Infections/epidemiology , Streptococcal Infections/etiology , Streptococcal Infections/surgery , Surgical Wound Infection/epidemiology , Surgical Wound Infection/microbiologyABSTRACT
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