piperacillin--tazobactam-drug-combination and Mediastinitis

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Biomarkers, Tumor; Dendritic Cell Sarcoma, Follicular; Dyspnea; Emergencies; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Firmicutes; Gram-Positive Bacterial Infections; Humans; Male; Mediastinal Neoplasms; Mediastinitis; Mouth; Piperacillin, Tazobactam Drug Combination; Tomography, X-Ray Computed

Descending necrotizing mediastinitis (DNM) is a now-rare complication of dental and pharyngeal infections. Reports in the literature have emphasized the need for early, aggressive surgical intervention. We present a case of DNM with bilateral empyemas that arose secondary to a perforated pharyngeal abscess. The patient was successfully managed conservatively with intravenous antibiotics and intercostal drainage. We conclude that conservative management with antibiotics and image-guided percutaneous pleural drainage may be initially appropriate for the stable patient.

Topics: Anti-Bacterial Agents; Bacteroidaceae Infections; Chest Tubes; Drainage; Empyema, Pleural; Haemophilus Infections; Humans; Male; Mediastinitis; Mediastinum; Middle Aged; Necrosis; Penicillanic Acid; Peritonsillar Abscess; Piperacillin; Piperacillin, Tazobactam Drug Combination; Rupture, Spontaneous; Streptococcal Infections; Tomography, X-Ray Computed