Incidence and Morbidity of Cytomegaloviral Infection in Patients with Mediastinitis following Cardiac Surgery

doi:10.1378/chest.97.1.18

Chest

Volume 97, Issue 1, January 1990, Pages 18-22

https://doi.org/10.1378/chest.97.1.18 Get rights and content

To determine the incidence and morbidity of infection with CMV associated with mediastinitis after conventional cardiac surgery, 115 consecutive adult patients with mediastinitis were evaluated with viral cultures of blood and urine. Shedding of CMV was seen in 29 patients (25 percent) within a mean period of 37 ± 22 days after cardiopulmonary bypass. Viremia was documented in 79 percent (23) of these 29 patients. Acute renal failure and enzymatic abnormalities (AST and LDH) were significantly more common in patients with virologically proven infection with CMV (p<0.05). In patients who survived the initial period of bacterial infection, major differences in their clinical course were observed according to their virologic status. After the 15th day of hospitalization following the débridement, the persistence of local infection was more frequent (p<0.05) and the mortality was higher (p<0.01) in CMV-infected patients. Moreover, the mean duration of hospitalization in the ICU for survivors was 69 ± 36 days in viral shedders, compared with 48 ± 27 days in nonshedders (p<0.05). Infection with CMV in mediastinitis occurs frequently and is associated with persistence of local infection, prolonged hospitalization, and increased late mortality.

(Chest 1990; 97:18-22)

Section snippets

Patients

From January 1981 to June 1986, some 136 consecutive adult patients were admitted to the ICU of Bichat Hospital, Paris, referred from seven Parisian surgical departments because of mediastinitis following cardiac surgery. Patients were included in the study when viral cultures could be performed within ten days after surgical débridement. Ten patients died before the cultures could be performed, and 11 others were excluded because of toxic or contaminated cultures. The group studied was

Incidence of CMV Excretion

Clinical characteristics of the 115 patients are shown in Table 1. Viral shedding was found in 29 (25 percent) of 115 patients, with CMV isolated from the blood in 20, from urine in six, and from both sites in three patients. The age, type of surgery, delay between ECC and first viral cultures, and serologic status were not different between VE + and VE– patients. A significant difference was observed in the sex ratio, with 31 percent females (9/29) in VE 4+ patients vs 10 percent (9/86) in VE

DISCUSSION

As early as 1968, blood transfusions used in cardiac surgery had been shown to be associated with risk of CMV infection, as evidenced by CMV serologic response;³^,⁴^,¹⁷ however, the incidence of reported CMV infection fluctuates between 40 percent in earlier studies2, 3, 4, 5^,¹⁷ and 1.5 to 12 percent in recent reports18, 19, 20, 21 and, when considering only viremia, between 0 and 1 percent.18, 19, 20 In our experience, such an incidence is low; during the period of October 1985 through June

ACKNOWLEDGMENTS

We thank Professor Susan Pingleton for helpful comments, the ICU nurses and the technical staff of the virologic laboratory for their active collaboration, and Miss M organe Kail and Miss Catherine Brun for manuscript preparation.

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Supported in part by a grant from the Faculté Xavier Bichat.

Presented in part at the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy, New Orleans, September 28-October 1, 1986.

Manuscript received March 16; revision accepted June 13.

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Chest

Clinical InvestigationsIncidence and Morbidity of Cytomegaloviral Infection in Patients with Mediastinitis following Cardiac Surgery

Section snippets

Patients

Incidence of CMV Excretion

DISCUSSION

ACKNOWLEDGMENTS

Am J Cardiol

Lancet

Lancet

Lancet

Chest

Kidney Int

Immunosuppression in viral infections

Rev Infect Dis

A syndrome following total body perfusion

Surg Gynecol Obstet

Antibody responses to the Epstein-Barr virus and cytomegaloviruses after open-heart and other surgery

N Engl J Med

A serologic study of cytomeglaovirus infections associated with blood transfusions

N Engl J Med

Epidemiology and transmission of cytomegalovirus

J Infect Dis

Depression of neutrophil function induced by viruses and its role in secondary microbial infections

Rev Infect Dis

Synergistic effect on mortality in mice with murine cytomegalovirus and Pseudomonas aeruginosa, Staphylococcus aureus or Candida albicans infections

Infect Immun

Lymphocytes subsets and natural killer cell responses during cytomegalovirus mononucleosis

Infect Immun

Suppression of natural killer cell activity and T cell proliferation by fresh isolates of human cytomegalovirus

J Infect Dis

Cytomegalovirus viremia and bacteremia in renal-allograft recipients

N Engl J Med

Increased pulmonary superinfections in cardiac-transplant patients undergoing primary cytomegalovirus infection

N Engl J Med

Clinical Investigations
Incidence and Morbidity of Cytomegaloviral Infection in Patients with Mediastinitis following Cardiac Surgery