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Daptomycin for treatment of methicillin-resistant Staphylococcus epidermidis saphenectomy wound infection after coronary artery bypass graft operation (CABG): a case report
© Schmitto et al; licensee BioMed Central Ltd. 2009
Received: 29 June 2009
Accepted: 11 September 2009
Published: 11 September 2009
We report a case of successful treatment of postoperative saphenectomy wound infection of the upper left leg with the antibiotic drug Daptomycin.
Since its first clinical use by Rene Favaloro in the 60's, the great saphenous vein has become the most commonly harvested conduit for revascularization in coronary artery bypass grafting (CABG) . In order to reduce morbidity and improve the recovery time associated with CABG procedures, various techniques have been developed including conventional conduit harvesting, minimally invasive and/or endoscopic harvesting procedures . Still, these surgical techniques are associated with significant complication rates e.g. wound infections, non-infective wound healing disturbances, postoperative pain, etc. . Avoiding and/or reducing these complication rates is of great medical and economic interest. Improvements would result in increased postoperative mobility and quality of life as well as reduced length of hospital stay following surgery resulting large cost savings. Although much research has focused on comparing less invasive and conventional harvest techniques, there is at present no consensus on the areas of postoperative antibiotic drug treatment of saphenectomy wound infections once an infection occurs. Further studies are required to compare treatment methods of saphenectomy wound infections by different antibiotic drugs. Although, Daptomycin has already been proven to be effective in the treatment of bacteremia and endocarditis [4, 5] caused by methilin-resistent Staphylococcus aureus [6, 7] and several case reports about its effectiveness in the field of cardiac surgery exist in the literature , there are still no cases describing the successful treatment of saphenectomy wound infections by Daptomycin.
Therefore, in this paper we report the first case of successful treatment of a postoperative wound infection after saphenectomy of the great saphenous vein of the upper left leg with the new antibiotic drug Daptomycin (Cubicin®, Novartis Pharma Corporation, Germany).
We report the case of a 68-year old man with severe, diffuse coronary artery disease who presented with two months of progressive angina-pectoris-symptoms. Coronary angiography verified 3-vessel-disease with significant stenoses of the main coronary branches (LAD 99%, RCX 80%, RCA 90%), moderately-decreased systolic left-ventricular function and ST-elevations in leads II, III and aVF. For these reasons, surgical revascularization was indicated. The patient had a significant history of arterial hypertension, Type II diabetes mellitus, adipositas, nicotine abuse (49 pack years), hypercholersterinemia and performance of PTCA of the left coronary artery in 2002.
In the Department of Thoracic-, Cardiac- and Vascular Surgery of the University of Goettingen, Germany, we performed CABG with three single vein-grafts to the diagonal branch (DB), right posterior descending artery (RPD) and left posterolateral circumflex artery (LPL). The left anterior descending artery (LAD) was revascularized by the left internal mammarian artery (LIMA). Harvest of the saphenous vein was performed by conventional open saphenectomy harvest technique which involved an incision extending from the left medial malleolus, along the medial aspect of the knee to the groin.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
We gratefully thank Mrs. A. Pencz and Mrs. A. Kiel for technical support of this study.
- Favaloro RG: Saphenous vein autograft replacement of severe segmental coronary artery occlusion: operative technique. Ann Thorac Surg. 1968, 5: 334-9.View ArticlePubMedGoogle Scholar
- Aziz O, Athanasiou T, Darzi A: Minimally invasive conduit harvesting: a systematic review. Eur J Cardiothorac Surg. 2006, 29 (3): 324-33. 10.1016/j.ejcts.2005.11.032.View ArticlePubMedGoogle Scholar
- Athanasiou T, Aziz O, Skapinakis P, Perunovic B, Hart J, Crossman MC, Gorgoulis V, Glenville B, Casula R: Leg wound infection after coronary artery bypass grafting: a meta-analysis comparing minimally invasive versus conventional vein harvesting. The Annals of Thoracic Surgery. 2003, 76 (6): 2141-2146. 10.1016/S0003-4975(03)01435-8.View ArticlePubMedGoogle Scholar
- Fowler VG, Boucher HW, Corey GR, Abrutyn E, Karchmer AW, Rupp ME, Levine DP, Chambers HF, Tally FP, Vigliani GA, Cabell CH, Link AS, DeMeyer I, Filler SG, Zervos M, Cook P, Parsonnet J, Bernstein JM, Price CS, Forrest GN, Fätkenheuer G, Gareca M, Rehm SJ, Brodt HR, Tice A, Cosgrove SE: S. aureus Endocarditis and Bacteremia Study Group Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med. 2006, 355 (7): 653-6. 10.1056/NEJMoa053783.View ArticlePubMedGoogle Scholar
- Furuya EY, Lowy FD: Antimicrobial strategies for the prevention and treatment of cardiovascular infections. Curr Opin Pharmacol. 2003, 3 (5): 464-9. 10.1016/j.coph.2003.05.004.View ArticlePubMedGoogle Scholar
- Marco F, de la Mària CG, Armero Y, Amat E, Soy D, Moreno A, del Río A, Almela M, Mestres CA, Gatell JM, Jiménez de Anta MT, Miró JM: Hospital Clinic Experimental Endocarditis Study Group. Daptomycin is effective in treatment of experimental endocarditis due to methicillin-resistant and glycopeptide-intermediate Staphylococcus aureus. Antimicrob Agents Chemother. 2008, 52 (7): 2538-43. 10.1128/AAC.00510-07.View ArticlePubMedPubMed CentralGoogle Scholar
- Cosgrove SE, Fowler VG: Optimizing therapy for methicillin-resistant Staphylococcus aureus bacteremia. Semin Respir Crit Care Med. 2007, 28 (6): 624-31. 10.1055/s-2007-996409.View ArticlePubMedGoogle Scholar
- Weis F, Beiras-Fernandez A, Kaczmarek I, Sodian R, Vicol C, Reichart B, Weis M: Daptomycin for eradication of a systemic infection with a methicillin-resistant-Staphylococcus aureus in a biventricular assist device recipient. Ann Thorac Surg. 2007, 84 (1): 269-70. 10.1016/j.athoracsur.2007.02.001.View ArticlePubMedGoogle Scholar
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