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Clinical Presentation and Management of Methicillin-Resistant Staphylococcus aureus Pericarditis—Systematic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9040103. [PMID: 35448079 PMCID: PMC9024581 DOI: 10.3390/jcdd9040103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/13/2022] Open
Abstract
In the expanding era of antibiotic resistance, new strains of Staphylococcus aureus have emerged which possess resistance to traditionally used antibiotics (MRSA). Our review aimed to systematically synthesize information on previously described MRSA pericarditis cases. The only criterion for inclusion was the isolation of MRSA from the pericardial space. Our review included 30 adult and 9 pediatric patients (aged: 7 months to 78 years). Comorbid conditions were seen in most adult patients, whereas no comorbidities were noted amongst the pediatric patients. Pericardial effusion was found in 94.9% of cases, with evidence of tamponade in 83.8%. All cases isolated MRSA from pericardial fluid and 25 cases (64.1%) had positive blood cultures for MRSA. Pericardiocentesis and antibiotics were used in all patients. The mortality rate amongst adults was 20.5%, with a mean survival of 21.8 days, and attributed to multi-organ failure associated with septic shock. No mortality was observed in the pediatric population. In adult patients, there was no statistical difference in symptom duration, antibiotic duration, presence of tamponade, age, and sex in relation to survival. Conclusion: MRSA pericarditis often presents with sepsis and is associated with significant mortality. As such, a high clinical suspicion is needed to proceed with proper tests such as echocardiography and pericardiocentesis. In more than one third of the cases, MRSA pericarditis occurs even in the absence of documented bacteremia.
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Jevtic D, Dumic I, Adam A, Barsoum MK, Hanna RD, Sprecher LJ, Antic M, Radovanovic M. Community-associated Methicillin-resistant Staphylococcus aureus pericarditis in an immunocompetent patient. IDCases 2022; 29:e01583. [PMID: 35912380 PMCID: PMC9335382 DOI: 10.1016/j.idcr.2022.e01583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Pericarditis caused by Methicillin-resistant Staphylococcus aureus (MRSA) is a rare infection, often seen in patients with chronic kidney disease, immunosuppression, or previous pericardial disease. The presentation can be dramatic with acute illness leading to septic and/or obstructive shock due to pericardial tamponade. Occasionally disease can have a more protracted, indolent, subacute clinical course. Case report We report a case of a 57-year-old male patient with a previous history of smoking and moderate alcohol use who presented with progressive dyspnea and cough. He was found to have a disseminated MRSA infection with pericarditis complicated by pericardial tamponade. Urgent pericardiocentesis yielded 1.1 liters of purulent fluid that grew MRSA. MRSA was also isolated from the blood and pleural fluid. The patient underwent left thoracotomy, decortication, and pericardial window and completed 3 weeks of intravenous vancomycin therapy, concluding in an excellent outcome. Conclusion Bacterial pericarditis is an exceptionally rare form of pericarditis which been traditionally associated with chronic medical conditions requiring a prolonged healthcare stay. However, it has lately been observed in healthy individuals with social habits such as smoking and alcohol consumption. Bacterial pericarditis must be recognized in a timely fashion and managed aggressively to prevent a devastating outcome. A multidisciplinary approach is advised, which includes a combination of pericardial drainage and aggressive antibiotic therapy. Such treatment often yields a positive outcome and good long-term prognosis.
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Affiliation(s)
- Dorde Jevtic
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Internal Medicine, Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Igor Dumic
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Adam Adam
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michel K. Barsoum
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Cardiology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Richard D. Hanna
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Cardiology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Lawrence J. Sprecher
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Marina Antic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Milan Radovanovic
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
- Corresponding author at: Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
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Chavarriaga A, Overcash J, Lightfoot H, Dougherty S. Septic Pericardial Tamponade after Fork Stab Wound to the Chest. Am Surg 2020. [DOI: 10.1177/000313481908501202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Jon Overcash
- Department of Surgery Wellstar Atlanta Medical Center Atlanta, Georgia
| | - Harrell Lightfoot
- Department of Surgery Wellstar Atlanta Medical Center Atlanta, Georgia
| | - Stacy Dougherty
- Department of Surgery Wellstar Atlanta Medical Center Atlanta, Georgia
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Ali L, Ghazzal A, Sallam T, Cuneo B. Rapidly Developing Methicillin-Resistant Staphylococcus Aureus Pericarditis and Pericardial Tamponade. Cureus 2020; 12:e8001. [PMID: 32528743 PMCID: PMC7279682 DOI: 10.7759/cureus.8001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Methicillin-resistant staphylococcus aureus (MRSA) pericarditis is a rare life-threatening infection. A 46-year-old female with hypertension, acquired immunodeficiency syndrome (AIDS) and recurrent neck abscesses, presented with a neck abscess and sepsis. Bloody purulent drainage from the abscess was found and antibiotics were started. Drainage was positive for MRSA. Four days after, course was complicated by acute pericarditis and pericardial tamponade; pericardial fluid was drained and was positive for MRSA. Vancomycin was continued, and aspirin and colchicine were started. Two days later, there was a recurrent pericardial fluid collection with loculation. Surgery was thought to be dangerous in the setting of CD4 count of 12. She was managed conservatively thereafter, with vancomycin, aspirin and colchicine, and was successfully discharged from the hospital.
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Affiliation(s)
- Laith Ali
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Amre Ghazzal
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Tariq Sallam
- Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian Cuneo
- Critical Care/Pulmonary Medicine, MedStar Washington Hospital Center, Washington, DC, USA
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