Suetsugu F, Akiyama K, Toyama A, Negishi K, Matsuda N, Shimamoto K, Oka T, Takahashi S
Department of Cardiovascular Surgery, Kohsei General Hospital, Tokyo, Japan.
Kyobu Geka. 1995 Feb;48(2):156-9.
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.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的纵隔炎仍是一种难以治疗的感染，即使在当今化疗先进的时代，其死亡率仍很高。作者报告了一例二尖瓣置换术后因MRSA引起纵隔炎并并发急性肾衰竭的病例。患者的纵隔已用含0.2%聚维酮碘的生理盐水彻底清洗，并接受了小剂量万古霉素化疗方案。患者病情进展良好，完全康复。我们患者的病情发展证实，对于并发急性肾衰竭的患者使用万古霉素进行化疗时，密切监测万古霉素血清浓度至关重要。间歇性小剂量静脉给药足以维持有效的万古霉素血清浓度。在我们的病例中，透析前和透析结束时测得的万古霉素血清浓度没有明显下降。
