{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:22:49Z","timestamp":1791915769475,"version":"4.3.4"},"reference-count":21,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T00:00:00Z","timestamp":1652659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Descending necrotizing mediastinitis (DNM) is an acute, rare, severe condition with high mortality, but the optimal management protocol is still controversial. We retrospectively analyzed the results of multidisciplinary management in patients treated for DNM at our center over the last twenty years. Fifteen male patients, mean age 49.07 \u00b1 14.92 years, were treated: 9 with cervico-pharyngeal etiopathogenesis, 3 peri-tonsillar\/tonsillar, 2 odontogenic, 1 post-surgical; 6 with DNM type I, 6 with type IIA, and 3 with type IIB (Endo\u2019s classification). Mean time between diagnosis and treatment was 2.24 \u00b1 1.61 days. In all cases, mediastinum drainage via thoracotomy was performed after neck drainage via cervicotomy, associated with tooth treatment in two; one required re-operation; tracheostomy was necessary in 9, temporary intensive care unit stay in 4; 6 developed complications, without post-operative mortality. Main isolated germs were Staphylococci and Candida; 7 had polymicrobial infection. The most used antibiotics were meropenem, metronidazole, teicoplanin, third-generation cephalosporins and clyndamicin; anti-fungal drugs were fluconazole, caspofungin and anidulafungin. On multivariate analysis, presence of cardiovascular disease was statistically significantly associated with longer chest tube duration and hospital stay. DNM requires early diagnosis and treatment to reduce mortality and morbidity. The most effective treatment should provide a multidisciplinary approach, combining cervicotomy and thoracotomy to drain all infectious collections with administration and monitoring of the proper antimicrobial therapy.<\/jats:p>","DOI":"10.3390\/antibiotics11050664","type":"journal-article","created":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T13:06:23Z","timestamp":1652706383000},"page":"664","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Multidisciplinary Approach in the Treatment of Descending Necrotizing Mediastinitis: Twenty-Year Single-Center Experience"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3336-0021","authenticated-orcid":false,"given":"Angela","family":"De Palma","sequence":"first","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko Girolamo","family":"Cantatore","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3453-5647","authenticated-orcid":false,"given":"Francesco","family":"Di Gennaro","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Signore","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Panza","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0860-1647","authenticated-orcid":false,"given":"Debora","family":"Brascia","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"De Iaco","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doroty","family":"Sampietro","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosatea","family":"Quercia","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Genualdo","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ondina","family":"Pizzuto","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Garofalo","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Signorile","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4833-7118","authenticated-orcid":false,"given":"Davide Fiore","family":"Bavaro","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7163-7437","authenticated-orcid":false,"given":"Gaetano","family":"Brindicci","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"De Gennaro","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Saracino","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6214-2336","authenticated-orcid":false,"given":"Nicola Antonio Adolfo","family":"Quaranta","sequence":"additional","affiliation":[{"name":"Otolaringology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari \u201cAldo Moro\u201d, Piazza Giulio Cesare 11, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Favia","sequence":"additional","affiliation":[{"name":"Complex Unit of 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