title: Mediastinitis due to Nocardia asteroides after cardiac transplantation.
abstract: Nocardia infection classically occurs in immuno-compromized patients. Only a few cases of mediastinal infection due to this pathogen have been described in the literature. We report a patient who developed mediastinitis due to Nocardia asteroides after cardiac transplantation. The treatment was surgical debridement, dressing, sugaring and antibiotic therapy. The emergence of a severe acute renal failure possibly induced by drug interaction between Cyclosporin, cyclines and aminoglycosides, led us to modify the antimicrobial treatment. The intravenous use of Imipenem 2 g per day and Ciprofloxacin 400 mg per day for four weeks and then oral Ciprofloxacin 1.5 g per day for 1 year, was effective and allowed a good outcome, without any drug interaction with Cyclosporin, adverse effect, graft rejection episode or infection relapse.
authors.affiliation: Service de Réanimation Polyvalente, CMC Foch, Suresnes, France.
authors.forename: F
authors.initials: F
authors.lastname: Thaler
authors.forename: B
authors.initials: B
authors.lastname: Gotainer
authors.forename: G
authors.initials: G
authors.lastname: Teodori
authors.forename: C
authors.initials: C
authors.lastname: Dubois
authors.forename: P
authors.initials: P
authors.lastname: Loirat
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002241:Carbohydrates / Q000627:therapeutic use; D003524:Cyclosporins / Q000009:adverse effects; D003646:Debridement; D004347:Drug Interactions; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008480:Mediastinitis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D009617:Nocardia Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D009616:Nocardia asteroides; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D002241:Carbohydrates; D003524:Cyclosporins