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Volume 18 Supplement 2

Sepsis 2014

  • Poster presentation
  • Open Access

Risk factors and incidence of mediastinitis in patients with lung abscess and sepsis

  • E Shalaeva1,
  • B Babadjanov1,
  • B Janabaev1 and
  • A Shalaeva1
Critical Care201418(Suppl 2):P8

https://doi.org/10.1186/cc14011

Published: 3 December 2014

Keywords

ObesityAnemiaLeft VentricleCongestive Heart FailureMediastinal Lymph Node

Introduction

Mediastinitis is a life-threatening condition, which is accompanied by high rates of mortality in cases of delayed diagnosis and inadequate treatment. The aim of the study was to identify the risk factors and incidence of mediastinitis in patients with lung abscess and sepsis.

Methods

In 2013, 218 consecutive patients (83 women and 135 men) with lung abscess and sepsis aged 45.8 ± 13.2 years were operated. They had a full range of laboratory and instrumental examinations, including echocardiography and computed tomography.

Results

Aerobic-anaerobic association in sputum was revealed in all patients with lung abscess and sepsis, Candida spp. in 34 (15.6%). Blood culture was positive only in 59 (27%) patients, which had not previously received antibacterial therapy (polymicrobial flora including Staphylococcus and Streptococcus specimen). Empyema was diagnosed in 123 patients (56.4%), 31 (14.2%) of them were complicated by mediastinitis. The main clinical symptoms of mediastinitis were hyperthermia (100%), dysphagia (83.8%), dyspnea (80.6%), chest pain (61.3%), orthopnea (61.3%), and tachycardia (87.1%). The computer tomography revealed an increase in mediastinum size with accumulation of fluids and fluid in the pleural cavities (100%), free gas in the mediastinum (45.1%), enlarged mediastinal lymph nodes (45.1%), and fluid in the pericardium cavity (48.4%). To analyze the risk factors, we include 31 patients with lung abscess and sepsis complicated by mediastinitis in the first group, and 187 patients without mediastenitis in the second group. Groups were similar in age (46.1 ± 8.2 years vs. 45.8 ± 13.2 years). A total 77.4% of patients with mediastinitis were women who suffered from type 2 diabetes (HbA1c = 9.7 ± 1.4%), congestive heart failure and anemia. Significant differences in the groups according to the data of laboratory and instrumental studies are presented in Table 1.
Table 1

Risk factors for mediastinitis in patients with lung abscess and sepsis

 

With mediastinitis (n= 31)

Without mediastinitis (n= 187)

P value

Gender, male/female, n (%)

7 (22.6)/24 (77.4)

128 (68.5)/59 (31.5)

0.001

Type 2 diabetes mellitus, n (%)

26 (83.9)

42 (22.5)

0.001

Body mass index

32.3 ± 5.3

27.8 ± 6.1

0.031

Hemoglobin (g/l)

87.9 ± 9.2

128.4 ± 18.4

< 0.001

Fibrinogen (mg%)

800 ± 200

533 ± 166

< 0.001

End-diastolic volume of the left ventricle (ml)

139 ± 27

108 ± 28

0.024

End-systolic volume of the left ventricle (ml)

66.1 ± 8.2

46.8 ± 10.4

< 0.001

Left ventricular ejection fraction (%)

52.4 ± 2.2

57.2 ± 3.4

0.002

Conclusion

In total, 14.2% of patients presented with lung abscess and sepsis complicated by mediastinitis, more commonly in women with diabetes mellitus, obesity, anemia and reduced ejection fraction of the left ventricle.

Authors’ Affiliations

(1)
Republican Center of Purulent Surgery and Complications of Diabetes, Tashkent Medical Academy, Tashkent, Uzbekistan

Copyright

© Shalaeva et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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