Descending necrotizing mediastinitis from upper respiratory infection

• Published in: The American journal of emergency medicine 2004-03, Vol.22 (2), p.125-126
• Main Authors: Chang, Kuang-Jui, Chen, Wen-Jone, Chen, Shey-Ying, Tsai, Kuang-Chau, Yuan, Ang
• Format: Article
• Language: English
• Subjects: Adolescent; Anaerobic bacteria; Antibiotics; Emergency medical care; Humans; Infections; Male; Mediastinitis - microbiology; Mediastinitis - pathology; Mortality; Necrosis; Ostomy; Pharyngitis - microbiology; Radiography; Redox potential; Streptococcal Infections - pathology; Symbiosis; Viridans Streptococci
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2003.12.016

The predominant anaerobes cultured are Prevotella and Porphyromonas species, Peptostreptococcus species, and Bacteroides fragilis.5 The anatomic characters of the neck and mediastinum, symbiosis between aerobic and anaerobic bacteria, and alteration of the redox potential and the microenvironment facilitating anaerobes growth can contribute to the fulminant course of DNM.6 Broad-spectrum antibiotic coverage such as cefoxitin, clindamycin, imipenem-cilastatin, a penicillin plus a β-lactamase inhibitor, and gentamicin are necessary.5 Although DNM is rare, it has a mortality rate of 40% to 50%, even in the era of antibiotics. Mediastinal gas presence strongly correlates with mediastinal infection.8 CT scanning can provide accurate information for the optimal thoracic approach for efficient surgical drainage.9 As DNM spreads rapidly from the neck downward to the mediastinum despite broad-spectrum antibiotic treatment.4,9,10 Early, adequate neck and thoracic surgical drainage (cervical exploration, thoracoscopic method, and thoracotomy) can reduce the mortality rate of DNM.