Retrospective Review of Management and Outcomes of Pediatric Descending Mediastinitis
Retrospective Review of Management and Outcomes of Pediatric Descending Mediastinitis
复制标题
小儿降性纵隔炎的治疗和结果的回顾性评价
DOI：
10.1177/0194599816634636
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Jerome W. Thompson
中科院分区：
文献类型：
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作者：
Caleb D. Wilson;K. Kennedy;Joshua W. Wood;T. K. Susheel Kumar;R. Stocks;Rebecca E. Thompson;Jerome W. Thompson
Objectives To review the management and outcomes of pediatric patients treated for descending mediastinitis at a single institution and contribute to an updated mortality rate. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods This study is a 19-patient case series of all patients treated for descending mediastinitis at a tertiary pediatric hospital from 1997 to 2015, and it serves as an update to the case series published from this institution in 2008. Review of management included time to diagnosis, time to surgery, surgical procedures performed, and antibiotics administered. The primary outcomes measured were length of hospitalization and mortality. Results In addition to 8 previously reported patients, we identified 11 pediatric patients treated for descending mediastinitis in the period of review. All 19 patients were <18 months old, and all survived their hospitalization. Fourteen patients underwent surgical drainage at least twice. The median length of hospital stay was 15 days. Retropharyngeal abscess was the source of infection in 16 of 19 patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the isolated organism in 14 of 15 positive cultures. Conclusion This review represents the largest reported series of pediatric patients with descending mediastinitis. With 100% survival, our results suggest that pediatric descending mediastinitis can be safely managed by prompt surgical drainage. Broad-spectrum antibiotics covering MRSA and a low threshold for repeat surgical intervention have been an important part of our successful approach and may decrease length of stay.
