Sielaff T D, Everett J E, Shumway S J, Wahoff D C, Bolman R M, Dunn D L
Department of Surgery, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA.
Ann Thorac Surg. 1996 Jan;61(1):99-103. doi: 10.1016/0003-4975(95)00826-8.
Postoperative Mycoplasma hominis sternal would or mediastinal infections are uncommon and difficult to diagnose. Atypical growth characteristics in routine bacterial culture, and the inability to demonstrate the organism on Gram stain, lead to delayed diagnosis of M hominis infections and increased morbidity.
Postoperative purulent would drainage or acute mediastinitis caused by M hominis developed in 3 cardiovascular surgery patients. These patients were considered along with 9 patients previously reported in the literature.
Operative findings included moderately thick, gray purulent fluid with the degree of tissue necrosis related to duration of infection. Intraoperative Gram stain of wound or mediastinal drainage demonstrated no microorganisms, and initial bacterial cultures did not reveal microbial growth. After an average of 4.5 days of culture, minute translucent colonies of M hominis were identified. The institution of appropriate antimycoplasma therapy (doxycycline and clindamycin) was associated with clinical or microbiological cure in all patients. Sternal wound complications developed in 3 patients, and a chronic infection developed in 1 patient.
Empiric therapy for M hominis infection should be considered in patients with mediastinitis or a sternal wound infection in which organisms are not observed on Gram stain and are not readily cultured.
人型支原体引起的术后胸骨伤口或纵隔感染并不常见，且难以诊断。常规细菌培养中其非典型生长特征以及革兰氏染色无法显示该病原体，导致人型支原体感染的诊断延迟且发病率增加。
3例心血管手术患者发生了由人型支原体引起的术后脓性伤口引流或急性纵隔炎。将这些患者与文献中先前报道的9例患者一起进行研究。
手术所见包括中等厚度的灰色脓性液体，组织坏死程度与感染持续时间有关。伤口或纵隔引流液的术中革兰氏染色未显示微生物，初始细菌培养未发现微生物生长。平均培养4.5天后，鉴定出人型支原体的微小半透明菌落。所有患者采用适当的抗支原体治疗（强力霉素和克林霉素）后均实现临床或微生物学治愈。3例患者出现胸骨伤口并发症，1例患者发生慢性感染。
对于纵隔炎或胸骨伤口感染患者，若革兰氏染色未观察到病原体且不易培养，应考虑经验性治疗人型支原体感染。
