Hariri et al reported cases of fungal mediastinitis following cardiac surgery. It is an uncommon condition but has a high mortality rate. The authors are from multiple institutions in France.
Patient selection: status post cardiac surgery
Risk factors:
(1) invasive cardiac support device
(2) heart transplantation
Clinical findings may include:
(1) infection with local inflammation and/or purulence showing a smoldering course
(2) fever
(3) septic shock
(4) leukocytosis
(5) mediastinal fluid collection on imaging studies
Diagnosis is usually based on a fungal culture or other microbiological test for a fungus.
The most common fungi in nonsurvivors included Candida species and Trichosporon.
Predictors of mortality:
(1) older age (61 to 73 for nonsurvivors; 53 to 65 for survivors; use >= 65 years)
(2) higher body mass index (24 to 32 for nonsurvivors; 20 to 26 for survivors; use >=26)
(3) higher SAPS II score on admission to the ICU (34 to 61 for nonsurvivors; 28 to 40 for survivors; use > 40)
(4) need for renal replacement therapy (OR 7.2)
(5) prolonged mechanical ventilation (OR 3.4)
