MRSA-related Empyema as Thoracic Surgical Site Infection

Abstract

The incidence of empyema as a thoracic surgical site infection (SSI) is relating low, but empyema related to MRSA poses an unenviable therapeutic challenge. We review 3 cases of MRSA-related empyema as SSI seem in the last 10 years, and evaluate therapeutic measures. All 3 subjects began being administered vancomycin (VCM) systemically once the diagnosis was established. Subject 1 developed MRSA-related empyema following pulmonary segmentectomy for small-cell lung cancer. The subject was treated following a diagnosis of incisional SSI, with delayed adequate pleural drainage, resulting in treatment difficulties, but was cured without becoming MRSA-negative. Subject 2 developed MRSA-related empyema following pulmonary lobectomy for advanced lung cancer associated with pneumoconiosis. Following bronchoplasty, a chest tube was placed for long-term drainage. The subject did not become MRSA-negative after VCM administration, but became so after linezolid treatment, facilitating a cure. Subject 3, who had secondary pneumothorax, underwent thoracoscopic partial hepatic resection. Intraoperative findings suggested pleural cavity infection, necessitating a prophylactic drain, but MRSA-related pyothorax developed. Fibrinolysis with urokinase effectively cleared up the poor drainage and the subject was cured without becoming MRSAnegative. In conclusion, in controlling MRSA-related empyema as SSI noted that : (1) long-term postperative thoracic drain retention may lead to retrograde infection ; (2) surgical procedures reducing the extent of pulmonary resection may effectively prevent pyothorax progression ; (3) for poor drainage in advanced pyothorax, fibrinolytic therapy is worth attempting before thoracoscopic surgery ; and (4) the timing for discontinuing anti-MRSA drugs should be determined based on the clinical course rather than negative conversion of bacteria.