title: [Intermittent mini-dose vancomycin intravenous administration and closed continuous irrigation technique applied to mediastinitis caused by MRSA following mitral valve replacement].
abstract: Mediastinitis caused by MRSA (Methicillin-Resistant Staphylococcus aureus) remains an intractable infection producing high mortality even in these days of advanced chemotherapy. The authors report a case of mediastinitis due to MRSA complicated with acute renal failure following mitral valve replacement. The patient's mediastinum had been thoroughly cleaned with physiological saline solution with 0.2% povidone iodine, and underwent a chemotherapy regimen of mini-dose vancomycin. The patient made favorable progress and recovered completely. Our patient's progress confirmed that when chemotherapy using vancomycin is administered in a patient whose condition is complicated with acute renal failure, closely monitoring the vancomycin serum concentration is essential. Intermittent mini-dose intravenous administration is sufficient to maintain an effective vancomycin serum concentration. In our case, vancomycin serum concentration measured before and at completion of dialysis revealed no appreciable decline.
authors.affiliation: Department of Cardiovascular Surgery, Kohsei General Hospital, Tokyo, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Suetsugu
authors.forename: K
authors.initials: K
authors.lastname: Akiyama
authors.forename: A
authors.initials: A
authors.lastname: Toyama
authors.forename: K
authors.initials: K
authors.lastname: Negishi
authors.forename: N
authors.initials: N
authors.lastname: Matsuda
authors.forename: K
authors.initials: K
authors.lastname: Shimamoto
authors.forename: T
authors.initials: T
authors.lastname: Oka
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008480:Mediastinitis / Q000188:drug therapy* / Q000209:etiology; D008482:Mediastinum; D016106:Methicillin Resistance; D008875:Middle Aged; D008943:Mitral Valve; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000209:etiology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D007507:Therapeutic Irrigation / Q000379:methods; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D014640:Vancomycin