ISSN: 1859 - 2872
Bacteriological characteristics and the antibiotic therapy in descending necrotizing mediastinitis caused by esophageal perforation on emergency at Viet Duc University Hospital
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Abstract
Objective: Aim of this paper is to analyze the isolated bacteriological characteristic and antibiotic therapy. Subject and method: A prospective and retrospective study of cases diagnosed descending necrotizing mediastinitis (DNM) due to perforation of the esophagus had been treated at Viet Duc Hospital from 1/2016 to 3/2019 including the deaths and discharged to die. The diagnosis of DNM was based on Estrera (1983) criterias. Result: A total of 40 cases, the ratio of male: female was 4.7:1, Age from 36 and 60 years old accounted for 60%. Esophageal perforation caused injury 70%, pathologies 30%; Bone caused 88.5% on injured cases. Perforation was located in 1/3 upper part 57.5%, 1/3 middle part 22.5% and 1/3 lower part 20%. Type I was 55%, and type IIb accounted for 45%, however, no type IIa was observed. Bacteriology isolation: 24/40 (60%) isolated were bacteria and fungi, 100% combines both anaerobic and aerobic, in which Gram (+) aerobic predominantly 75.9%, commonly were Streptococcus species in 37.5%, Enterococcus faecalis in 20.8%, Acinetobacter Baumanii 20.8%. Gram (-) aerobic accounted for 17.2%, commonly are Klebsiella pneumonie 12.5%, Pseudomonas aeruginosa 12%, Gram (+) anaerobic: Peptostreptococcus accounted for 8.3%, fungi was isolated in 6/24: 25%. Antibiotics: Cephalosporin (3rd generation) and carbapenem match antibiotic results, 100% combination with metronidazole. Outcomes: Postoperative complications were 7 cases (17.5%). Mortality was 3 cases due to bleeding and multiple organ failure, accounted for 7.5%. Conclusion: Research shows that aerobic and anaerobic combined bacteria account for 100%, aerobic Gram (+) predominance of which Streptococcus species, Gram (-) are common Klebsiella pneumoniae and Pseudomonas aeruginosa; anaerobic Gram (+) single Peptostreptococcus. Antibiotic used by experience are broad spectrum and strong such as cephalosporin (3nd generation) and carbapenem, which is suitable with results of antibiogram, and combined metronidazole.
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