Sakurai H, Tamaki S, Hara S, Nishizawa T, Murayama H, Murase M
Department of Cardiovascular Surgery, Shakaihoken Chukyo Hospital, 1-1-10 Sanjo, Minami-ku, Nagoya 457-8510, Japan.
Ann Thorac Cardiovasc Surg. 1998 Aug;4(4):226-9.
A 72 year-old man underwent a Bentall procedure for aortic regurgitation secondary to annulo-aortic ectasia and ascending aortic aneurysm. On the 11th postoperative day, the C-reactive protein (CRP) level and white blood cell (WBC) count rose. Echocardiography and a computed tomographic scan showed the appearance of pericardial effusion. A diagnosis of mediastinitis and composite graft infection was made, and mediastinal drainage and irrigation were performed. Methicillin-resistant coagulase negative staphylococcus (MRCNS) was identified as the causative organism. Vancomycin, arbekacin and minocycline were used intravenously. Additionally, a continuous mediastinal irrigation was performed through the chest tubes. CRP level and WBC count were gradually reduced to normal range. He has now been free from signs of infection for more than 3 years. Because MRCNS is considered less virulent than methicillin-resistant Staphylococcus aureus, mediastinitis and composite graft infection due to MRCNS might be treatable by such conservative therapy even in patients with prosthetic implants. Since MRCNS often becomes ubiquitous, preventing infections by strict attention to asepsis is important.
一名72岁男性因瓣环主动脉扩张和升主动脉瘤继发主动脉瓣关闭不全接受了Bentall手术。术后第11天，C反应蛋白（CRP）水平和白细胞（WBC）计数升高。超声心动图和计算机断层扫描显示有心包积液。诊断为纵隔炎和人工血管复合移植物感染，并进行了纵隔引流和冲洗。耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）被确定为病原体。静脉使用万古霉素、阿贝卡星和米诺环素。此外，通过胸管进行持续纵隔冲洗。CRP水平和WBC计数逐渐降至正常范围。他现在已无感染迹象超过3年。由于MRCNS被认为比耐甲氧西林金黄色葡萄球菌毒力低，即使是有假体植入物的患者，由MRCNS引起的纵隔炎和人工血管复合移植物感染也可能通过这种保守治疗治愈。由于MRCNS常常无处不在，严格注意无菌操作以预防感染很重要。
