Mediastinitis rare but fatal after paediatric cardiac surgery

A recent study has found a low incidence of mediastinitis, a rare complication of neonatal cardiac surgery, at a tertiary referral centre, but mortality is high. Fungal infection is the main predictor of death.

The authors performed a retrospective review of mediastinitis cases in children following congenital heart surgery over a 10-year period (2013‒2023) at Necker Hospital in Paris, France.

Mediastinitis had a cumulative incidence of 0.74 percent (95 percent confidence interval [CI], 0.56‒0.96), with 57 cases of 7,665 interventions. The median age at surgery was 12 days, with 58 percent of patients aged <1 month. The majority of patients (n=34, 60 percent) had delayed sternal closure.

Staphylococcus spp. (45 percent) was the most common microorganism, followed by Gram-negative bacteria (36 percent) and fungi (9 percent).

Surgical debridement was performed in all patients, 46 (81 percent) in the operating room and 11 (19 percent) in the intensive care unit (ICU). The median length of stay was 21 days in the ICU and 35 days until hospital discharge. Fifteen deaths occurred (27 percent), with 12 occurring in the ICU.

Univariate analysis revealed the following risk factors for mortality: surgical revision in the ICU vs operating room (odds ratio [OR], 4.9, 95 percent CI, 1.3‒19.9), delayed sternal closure superior to 3 days (OR, 5.0, 95 percent CI, 1.3‒16.5), and fungal mediastinitis (OR, 14.9, 95 percent CI, 2.0‒185.4).

However, in multivariate analysis, only fungal infection remained a significant predictor of mortality (OR, 25.4, 95 percent CI, 2.7‒608).