Non-surgical management of methicillin-sensitive Staphylococcus aureus bacteremia-related mediastinitis

Authors

• Carlo Vignati Department of Critical Cardiology and Rehabilitation, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
• Alessandra Pietragalla Department of Critical Cardiology and Rehabilitation, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
• Gianfranco Dedivitiis Department of Infectious Diseases, Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
• Maria Elisabetta Mancini Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
• Piergiuseppe Agostoni Department of Critical Cardiology and Rehabilitation, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy

carlo.vignati@ccfm.it

Keywords

Abstract

Background: Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive Staphylococcus aureus.
Case presentation: In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess.
Conclusion: We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach.

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