cefotaxime and Mediastinitis

Occasionally, trivial odontogenic infections may develop into complex diseases. This may even result in an unrestrained phlegmonous spread causing life-threatening complications. These problems have decreased since the introduction of antibiotics and also due to improved oral hygiene and improved diagnostic measures resulting in optimized medical treatment. However, life-threatening forms are still seen, in particular if infections spread along the cervical fascial sheaths down towards to the mediastinum. Over the past decade the number of critical infections has increased in other medical specialties. This is usually explained by the development of multiresistant pathogens in the context of nosocomial infections.. We reviewed the patients' records of the past 15 years at the Department of Oral and Maxillofacial Surgery of the University Hospital Kiel to assess a possible increase of odontogenic infections with life-threatening complications. From 1990 to 2004, four patients with odontogenic infections exhibiting critical phlegmonous spread were treated in the intensive care unit. Two patients developed bacterial mediastinitis which could be controlled by intravenous antibiotics only. One patient progressed to general septic mediastinitis and eventually died of cardiorespiratory arrest. The last patient also had septic mediastinitis and developed right pleural empyema. Several operations were necessary before the disease could be controlled. This patient's case report is presented in detail.. The prognosis of patients with mediastinitis crucially depends on (a) early diagnosis including computed tomography of the neck and thorax, (b) early radical surgical intervention, and (c) optimized pathogen-oriented antibiotic treatment.

Topics: Abscess; Ampicillin; Cefotaxime; Cellulitis; Combined Modality Therapy; Critical Care; Disease Progression; Empyema, Pleural; Follow-Up Studies; Humans; Male; Mediastinitis; Middle Aged; Neck; Reoperation; Shock, Septic; Staphylococcal Infections; Staphylococcus epidermidis; Streptococcal Infections; Sulbactam; Therapeutic Irrigation; Thoracotomy; Tomography, X-Ray Computed; Vancomycin

A rare case of supraglottitis complicated by mediastinitis is presented. Despite aggressive treatment with broadspectrum intravenous antibiotics, the patient persisted to have generalized supraglottitis. Subsequent computed tomography (CT) scanning revealed that she had developed a frank fluid collection starting at the suprasternal notch, extending retrosternally into the superior mediastinum. She recovered with conservative management and did not require aggressive mediastinal drainage as advocated by the literature.

Topics: Aged; Anti-Infective Agents; Cefotaxime; Cefuroxime; Cephalosporins; Drug Therapy, Combination; Female; Floxacillin; Glottis; Humans; Infusions, Intravenous; Laryngitis; Mediastinitis; Metronidazole; Penicillins; Tomography, X-Ray Computed; Treatment Outcome

The study was conducted in a group of 440 patients who underwent planned operations for ischemic heart disease. Three current methods of preventive antibiotic therapy were compared. The influence of various risk factors on the incidence of infectious complications was analysed. Experience with closed mediastinitis management was also analysed. The effect of a short-term (1-3 days) course of claforan in prevention of infectious complications is the same as that of a 5-7-day course of cefamezin or gentamicin. Postoperative mediastinitis developed in 11 (2.5%) patients. It was managed in all patients by closed irrigation and drainage of the retrosternal space. The average duration of mediastinal irrigation was 7.4 days. Convalescence was attained in all cases.

Topics: Cefazolin; Cefotaxime; Combined Modality Therapy; Drainage; Drug Therapy, Combination; Gentamicins; Humans; Mediastinitis; Middle Aged; Myocardial Revascularization; Postoperative Complications; Risk Factors; Time Factors