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Moyon, Quentin; Lebreton, Guillaume; Huang, Florent; Demondion, Pierre; Desnos, Cyrielle; Chommeloux, Juliette; Hékimian, Guillaume; Bréchot, Nicolas; Nieszkowska, Ania; Schmidt, Matthieu; Leprince, Pascal; Combes, Alain; Luyt, Charles-Edouard; Pineton de Chambrun, Marc

Characteristics and outcomes of patients with postoperative Candida versus bacterial mediastinitis: a case-matched comparative study

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  • Media type: E-Article
  • Title: Characteristics and outcomes of patients with postoperative Candida versus bacterial mediastinitis: a case-matched comparative study
  • Contributor: Moyon, Quentin; Lebreton, Guillaume; Huang, Florent; Demondion, Pierre; Desnos, Cyrielle; Chommeloux, Juliette; Hékimian, Guillaume; Bréchot, Nicolas; Nieszkowska, Ania; Schmidt, Matthieu; Leprince, Pascal; Combes, Alain; Luyt, Charles-Edouard; Pineton de Chambrun, Marc
  • imprint: Oxford University Press (OUP), 2022
  • Published in: European Journal of Cardio-Thoracic Surgery
  • Language: English
  • DOI: 10.1093/ejcts/ezab437
  • ISSN: 1010-7940; 1873-734X
  • Keywords: Cardiology and Cardiovascular Medicine ; Pulmonary and Respiratory Medicine ; General Medicine ; Surgery
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>OBJECTIVES</jats:title> <jats:p>Postoperative mediastinitis, a feared complication after cardiac surgery, is associated with high mortality, especially of critically ill patients. Candida species infections are rare and severe, with poorly known outcomes. We conducted a case–control study to describe the characteristics, management and outcomes of patients with postoperative Candida mediastinitis.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This French, monocentre, retrospective study included all patients with postoperative Candida mediastinitis (January 2003–February 2020) requiring intensive care unit admission. Candida mediastinitis patients (henceforth cases) were matched 1:1 with postoperative bacterial mediastinitis (henceforth control), based on 3 factors during mediastinitis management: age &amp;gt;40 years, cardiac transplantation and invasive circulatory device used. The primary end point was the probability of survival within 1 year after intensive care unit (ICU) admission.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Forty cases were matched to 40 controls. The global male/female ratio was 2.1, with mean age at admission 47.9 ± 13.8 years. Candida species were: 67.5% albicans, 17.5% glabrata, 15% parapsilosis, 5.0% tropicalis, 2.5% krusei and 2.5% lusitaniae. The median duration of mechanical ventilation was 23, 68.8% of patients received renal replacement therapy and 62.5% extracorporeal membrane oxygenation support. The probability of survival within the first year after ICU admission was 40 ± 5.5% and was significantly lower for cases than for controls (43 ± 8% vs 80 ± 6.3%, respectively; Log-rank test: P &amp;lt; 0.0001). The multivariable Cox proportional hazards model retained only renal replacement therapy [hazard ratio (HR) 3.7, 95% confidence interval (CI) 1.1–13.1; P = 0.04] and Candida mediastinitis (HR 2.4, 95% CI 1.1–5.6; P = 0.04) as independently associated with 1-year mortality.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Candida mediastinitis is a serious event after cardiac surgery and independently associated with 1-year mortality. Further studies are needed to determine whether deaths are directly attributable to Candida mediastinitis.</jats:p> </jats:sec>
  • Access State: Open Access