Infectious Disease Compendium

Mediastinitis

Diagnosis

Pus in the mediastinum.

Epidemiologic Risks

Usually trauma, post surgical, or esophageal perforation (I had one guy who perforated his esophagitis from a tortilla chip). Neck infections can track down into the mediastinum.

Microbiology

Trauma and post operative tends to be S. aureus and S. epidermidis.

Esophageal perforation and head&neck infections tend towards mixed infections with viridans and other streptococci, Peptostreptococcus, Bacteroides, and oral anaerobes.

Occasionally actinomycosis will burrow into the mediastinum.

Empiric Therapy

Trauma and post operative: anti staphylococcal therapy.

Esophageal perforation or head&neck infection: (penicillin G OR ampicillin PLUS metronidazole) OR (third generation cephalosporins PLUS metronidazole) OR (quinolone PLUS metronidazole) OR penicillin/beta-lactamase inhibitors OR clindamycin OR cefoxitin OR cefotetan.

Drain the pus, always drain the pus.

Pearls

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Mediastinitis 519.2; actinomycotic 039.8; syphilitic 095.8; tuberculous 012.8.