Postpneumonectomy MRSA empyema treated with vacuum therapy – case report and literature review
Authors:
P. Horák; K. Jágrová; J. Fulík; A. Erbenová; J. Fanta
Authors‘ workplace:
Chirurgická klinika 1. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Bulovka, Praha
Published in:
Rozhl. Chir., 2021, roč. 100, č. 10, s. 502-506.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2021.100.10.502–506
Overview
Introduction: Postpneumonectomy empyema is one of serious complications with high mortality and lethality. In this paper, the authors describe the treatment of methicillin-resistant Staphylococcus aureus-induced postpneumonectomy empyema by vacuum therapy in a patient operated on for malignant pleural mesothelioma.
Case report: A 64-year-old patient was operated on at our clinic for epithelioid mesothelioma of the right pleural cavity. We performed extrapleural pneumonectomy with intraoperative hyperthermic intrathoracic chemotherapy. Seven weeks after surgery the patient was readmitted for right pleural cavity empyema caused by methicillin-resistant Staphylococcus aureus (MRSA). Following pleural cavity debridement and mesh explantation we applied vacuum therapy. In total, we performed 4 dressing changes with final application of an antibiotic solution into the pleural cavity and wound closure. The patient showed no evidence of recurrent empyema during subsequent 12-month follow-up and underwent chemotherapy.
Conclusion: Vacuum therapy is an effective treatment of postpneumonectomy empyema in patients without a bronchopleural fistula; nevertheless, specific postpneumonectomy patient care is required.
Keywords:
vacuum therapy – Methicillin-resistant Staphylococcus aureus – malignant pleural mesothelioma – pneumonectomy – empyema
Sources
1. Miller Jr. JI. Postsurgical empyema. In: Shields TW, Locicero J, Ponn RB, et al. General thoracic surgery. 6. ed. vol. 2. Lippincott, Williams & Wilkins 2000:833−839.
2. Stolz A, Pafko P. Postpneumonický empyém a bronchopleurální píštěl In: Komplikace v hrudní chirurgii 1. vydání. Praha, Grada Publishing, a.s. 2010:191–202.
3. Deschamps C, Pairolero PC, Allen MS, et al. Management of postpneumonectomy empyema and bronchopleural fistula. Chest Surg Clin N Am. 1996 Aug;6(3):519−327.
4. Celik A, Yekeler E, Aydin E, et al. Treatment of persistent postpneumonectomy empyema by vacuum-assisted management: An analysis of nine patients. Thorac Cardiovasc Surg. 2013 Oct;61(7):631−635. doi: 10.1055/s-0032-1331263.
5. Al Muffarej F, Margolis M, Tempesta B, et al. Outpatient management of post-pneumonectomy and post-lobectomy empyema using the vacuum-assisted closure system. Surgery Today 2010 Aug;40(8):711−718. doi: 10.1007/s00595- 008-4096-9.
6. Han X, Yin M, Li L, et al. Customized airway stenting for bronchopleural fistula after pulmonary resection by interventional technique: single center study of 148 consecutive patients. Surgical Endoscopy 2018;32:4116−4124. https:// doi.org/10.1007/s00464-018-6152-x.
7. Chawla RK, Madan A, Bhardwaj PK, et al. Bronchoscopic management of bronchopleural fistula with intrabronchial instillation of glue (N-butyl cyanoacrylate). Lung India 2012 Jan- Mar;29(1):11–14.doi: 10.4103/0970- 2113.92350.
8. Battistoni P, Caterino U, Batzella S, et al. The use of polyvinyl alcohol sponge and cyanoacrylate glue in the treatment of large and chronic bronchopleural fistulae following lung cancer resection. Respiration 2017;94:58−61. doi: 10.1159/000477350.
9. Schreiner W, Oster O, Stapel P, et al. V.A.C.-INSTILL-Therapie – Neue Wege in der septichsen Thoraxchirurgie. Zentrallblatt für Chirurgie 2013 Feb;138(1):117−120. doi: 10.1055/s- 0032-1315201.
10. Rocco G, Cecere C, La Rocca A, et al. Caveats in using vacuum-assisted closure for post-pneumonectomy empyema. European Journal of Cardio-Thoracic Surgery 2012 May;41(5):1069−1071. doi: 10.1093/ ejcts/ezr196.
11. Laperuta P, Napolitano F, Vatrella A, et al. Post-pneumonectomy broncho-pleural fistula successfully closed by open-window thoracostomy associated with V.A.C. therapy. International Journal of Surgery 2014; 12 Suppl 2:S17−S19. doi: 10.1016/j. ijsu.2014.08.390.
12. Kim AW. Delayed gratification is better than no gratification. The Journal of Thoracic and Cardiovascular Surgery 2015 Mar;149(3):751. doi: 10.1016/j. jtcvs.2014.11.065.
13. Schneiter D, Weder W. Accelerated treatment of post-pneumonectomy empyema. In: Kuzdzal J, Asamura H, Detterbeck F, et al. ESTS Textbook of thoracic surgery. Cracow, Medycyna Praktyczna 2014:271−275.
14. Karapiner K, Saydam Ö, Metin M, et al. Experience with vacuum-assisted closure in the management of postpneumonectomy empyema: An analysis of eight cases. Thorac Cardiovasc Surg. 2016 Apr;64(3):258−262. doi: 10.1055/s-0034- 1390505.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 10
Most read in this issue
- Sacral neuromodulation for faecal incontinence – 10 years experience and long-term outcomes of a specialized centre
- Bronchogenic cyst of gastric cardia – case report and literature review
- Delirious conditions in surgical ICU – case report
- Peritoneal surface malignancy spread − reoperations after cytoreductive surgery + HIPEC