Hameed Irbaz, Ahmed Adham, Gandhi Shiv, Nassiri Naiem, Steinbacher Derek M, Vallabhajosyula Prashanth
Division of Cardiothoracic Surgery, Division of Surgery Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
JACC Case Rep. 2024 Dec 4;29(23):102816. doi: 10.1016/j.jaccas.2024.102816.
A 47-year-old woman presented to our hospital with Stanford type B aortic dissection with retrograde arch extension. The decision was made to undergo hybrid arch repair with thoracic endovascular aortic repair. The patient underwent surgery, but her intraoperative course was complicated by delayed sternal closure and mediastinitis requiring flap reconstruction. Recurrent pan resistant sternal wound infection (SWI) was observed, for which successful investigational bacteriophage therapy initiated through mediastinal drains. She remains infection-free at 2-year follow-up. SWI is a morbid complication following cardiac surgery, particularly when colonized by pan-resistant bacterium. Phage therapy refers to the therapeutic use of modified bacteriophages and have been previously described for use in mediastinitis. We report the use of phage therapy to treat SWI in our patient. This case report adds to the current evidence supporting the use of phage therapy for treatment of complicated mediastinal wound infection following aortic arch surgery.
一名47岁女性因 Stanford B 型主动脉夹层伴逆行性主动脉弓扩展入住我院。决定采用胸主动脉腔内修复术进行杂交主动脉弓修复。患者接受了手术，但其术中过程因胸骨延迟闭合和纵隔炎而复杂化，需要进行皮瓣重建。观察到复发性全耐药性胸骨伤口感染（SWI），通过纵隔引流启动了成功的研究性噬菌体治疗。在2年随访中，她仍无感染。SWI是心脏手术后的一种严重并发症，特别是当被全耐药菌定植时。噬菌体治疗是指使用经过修饰的噬菌体进行治疗，此前已有用于纵隔炎的报道。我们报告了使用噬菌体治疗我们患者的SWI。本病例报告增加了当前支持使用噬菌体治疗主动脉弓手术后复杂纵隔伤口感染的证据。
