IJCS | Volume 31, Nº2, March / April 2018

DOI: 10.5935/2359-4802.20180004 Introduction Mediastinitis is a severe post-median sternotomy infection, affecting the adjacent deep tissues, with clinical and/or microbiological evidence of retrosternal space involvement, which may be associated with sternal osteomyelitis, with or without instability. 1,2 It has an incidence of 0.4% to 5% and highmortality (14% to 47%) 3 . Evenwith early diagnosis and treatment, it does not have a good prognosis, especially in the presence of sepsis and other health problems 4 . The risk factors associated with mediastinitis are pre‑surgical, surgical and post-surgical ones. 5 Pre-surgical factors include older age, male gender, malnutrition, obesity, smoking, Diabetes mellitus (DM) and other diseases, 5,6 as well as chronic renal failure (CRF) and/or creatinine serum levels > 1.5mg/dL and Left Ventricular Ejection Fraction (LVEF) < 40%. 7,8 Surgical risk factors include the type of surgery (elective or urgent), prolonged surgical time, coronary artery bypass grafting (CABG) using bilateral mammary arteries, and intra-aortic balloon insertion 9,10 . Routine procedures such as hair removal and the time elapsed between hair removal and the surgical incision, in addition to the sterilization of the surgical materials and the number of people in the operating 163 International Journal of Cardiovascular Sciences. 2018;31(2)163-172 ORIGINAL ARTICLE Mailing Address: Isabel Cristina Gomes • Rua José Ferreira da Luz, 44. Postal Code 30750-480, Caiçaras, Belo Horizonte, MG – Brazil. E-mail: icgomes04@yahoo.com.br , isabel.gomes@feluma.org.br Factors Associated with Post-Sternotomy Mediastinitis. Case-Control Study Débora Cristine Gomes Pinto, Antônio Fernandino de Castro Bahia Neto, Flávia Lage Gonçalves, Isabel Cristina Gomes, Eduardo Back Sternick, Alessandra Maciel Almeida, Nulma Souto Jentzsch Faculdade Ciências Médicas de Minas Gerais, Minas Gerais, MG – Brazil Manuscript received March 8, 2017, revised manuscript September 20, 2017, accepted September 22, 2017 Abstract Background: Mediastinitis is a severe post-median sternotomy infection with poor prognosis, even with early diagnosis and treatment. Objectives: To evaluate the profile of patients submitted to sternotomy, identify the risk factors for the development of mediastinitis and evaluate the bacteriological diagnosis of patients with this infection. Methods: Case-control study carried out in a large hospital in Belo Horizonte (MG, Brazil) in patients submitted to median sternotomy, from January 2015 to January 2018. The sample consisted of 65 patients, of which 13 were cases and 52, controls (1:4). For the statistical analysis, Student’s t test, Mann-Whitney test and Fisher exact test were used, in addition to logistic regression, with a level of significance of 5%. Results: There was a predominance of males (63.1%), and the mean age was 58.8 ± 10.3 years. Evolution to death occurred in 9.2% of the patients and in 23.1% of those with mediastinitis. Myocardial revascularization was performed in 75.4% of the cases. Predominance of male gender, longer hospitalization time, post-surgical fever and death, and a greater number of risk factors were more frequent characteristics in patients who developed mediastinitis. The most common microorganism found in patients with mediastinal infection was Staphylococcus aureus (30.7%), in addition to a high occurrence of Gram-negative bacteria (46,2%). Conclusion: The results are in accordance with the literature. Efforts should be focused on the control of risk factors prior to the procedure, in addition to improving measures that can decrease or eliminate the onset of mediastinitis, aiming at infection prevention and control. (Int J Cardiovasc Sci. 2018;31(2)163-172) Keywords: Mediastinitis; Risk factors; Thoracic surgery; Surgical wound infection.