Efficacy of continuous cleansing with teicoplanin on post-CABG methicillin-resistant staphylococcus aureus (MRSA) mediastinitis: report of a case.
The patient was a 48-year-old male who was diagnosed with unstable angina. He had worsening cardiogenic shock during coronary angiography. Emergency coronary artery bypass grafting (CABG) was performed. He had a methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis on day 22 after CABG. Drains were placed in the anterior mediastinum, left thoracic cavity, and abscess cavity, and another drain was placed in the mediastinal space for continuous cleansing with povidone iodine, oxydol. For antibiotics, teicoplanin (TEIC) was administered intravenously and to the local site via the cleansing drain for about one month. No MRSA was detected by culture in discharges from the mediastinal drain. Inflammatory findings were improved, and the patient was discharged and resumed everyday life without recurrence of inflammation as of eight months. Although the number of cases of MRSA mediastinitis is small and accumulation of cases is necessary to investigate therapeutic methods and selection of antibiotics, our department will select closed continuous cleansing and TEIC for antibiotics as the first choice for MRSA mediastinitis, and accumulate cases to investigate its efficacy.
Sezai
Akira
A
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
Shiono
Motomi
M
Inoue
Tatsuya
T
Hata
Mitsumasa
M
Iida
Mitsuru
M
Niino
Tetsuya
T
Saito
Akira
A
Hattori
Tsutomu
T
Wakui
Shinji
S
Soeda
Masao
M
Negishi
Nanao
N
Sezai
Yukiyasu
Y
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy* / Q000382:microbiology; D016106:Methicillin Resistance; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D017334:Teicoplanin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D017334:Teicoplanin