초록접수 현황
| 20F-088 | 구연 발표 |
Routine culture of mediastinal drainage fluid is useful in early diagnosis of post-sternotomy mediastinitis
Yochun Jung1, Kyo Seon Lee1, Sang Gi Oh1, Kook Joo Na2, Yangseung Jeong3
1Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea
2Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun, South Korea
3Department of Biology, Middle Tennessee State University, Tennessee, United States
Purpose : No reliable method has been established for early diagnosis of post-sternotomy mediastinitis (PSM). Since 2016, we have routinely performed mediastinal drainage fluid cultures (MDFC) in patients who underwent sternotomy. This study aims to validate the usefulness of MDFC in early diagnosis of PSM.
Methods : Since November 2016 and April 2020, MDFC were performed in 1,012 patients. MDFC were performed on the postoperative 3rd day. When bacteria were identified, additional MDFC or blood cultures were performed to reduce the possibility of false-positives. Medical records were retrospectively reviewed to confirm the development of PSM within postoperative 3 months.
Results : Bacteria were identified in the MDFC of 29 patients, and eight of them were diagnosed with PSM. Among the 983 patients with negative MDFC, only 15 cases of PSM occurred. The patients with PSM (n=23) and non-PSM (n=989) showed significant differences in the presence of end-stage renal disease, sternotomy history, postoperative renal replacement therapy, positive MDFC and aortic cross-clamp time. The result of binary logistic regression analysis showed that the ‘presence of sternotomy history’ and ‘positive MDFC’ were statistically significant factors in the PSM occurrence. Positive MDFC was regarded as true-positive if (1) PSM occurred afterwards, and/or (2) the same bacteria were identified in the additional MDFC/blood cultures; however, if PSM did not occur without antibiotic treatment, it was regarded as false-positive. The sensitivity, specificity, positive and negative predictive value of positive MDFC for diagnosis of PSM were 50.0%, 98.5%, 42.3%, and 99.0%, respectively.
Conclusion : Routine MDFC after sternotomy contributes to an early diagnosis of PSM.
Methods : Since November 2016 and April 2020, MDFC were performed in 1,012 patients. MDFC were performed on the postoperative 3rd day. When bacteria were identified, additional MDFC or blood cultures were performed to reduce the possibility of false-positives. Medical records were retrospectively reviewed to confirm the development of PSM within postoperative 3 months.
Results : Bacteria were identified in the MDFC of 29 patients, and eight of them were diagnosed with PSM. Among the 983 patients with negative MDFC, only 15 cases of PSM occurred. The patients with PSM (n=23) and non-PSM (n=989) showed significant differences in the presence of end-stage renal disease, sternotomy history, postoperative renal replacement therapy, positive MDFC and aortic cross-clamp time. The result of binary logistic regression analysis showed that the ‘presence of sternotomy history’ and ‘positive MDFC’ were statistically significant factors in the PSM occurrence. Positive MDFC was regarded as true-positive if (1) PSM occurred afterwards, and/or (2) the same bacteria were identified in the additional MDFC/blood cultures; however, if PSM did not occur without antibiotic treatment, it was regarded as false-positive. The sensitivity, specificity, positive and negative predictive value of positive MDFC for diagnosis of PSM were 50.0%, 98.5%, 42.3%, and 99.0%, respectively.
Conclusion : Routine MDFC after sternotomy contributes to an early diagnosis of PSM.
책임저자: 정요천
전남대학교병원 흉부외과
발표자: 정요천, E-mail : yochuni@naver.com