Successful Management of Pericardial Empyema due to Staphylococcus aureus Bacteremia

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Hintergrund Pericardial empyema is a rare entity in the era of modern antibiotic therapy and usually occurs as a secondary infection in the context of bacteremia or after thoracic procedures. The course is characterized by high mortality due to pericardial tamponade and sepsis, as well as the development of constrictive pericarditis in the long term. A standard therapeutic approach does not exist. Material und Methode We report the case of a 32-year-old man who presented to the emergency department of his local hospital due to symptomatic pericardial empyema with detection of Staphylococcus aureus in blood culture 4 weeks prior. Ergebnis He had a history of diabetes mellitus and regular alcohol consumption (6 bottles of beer/day). Diagnostically, an organized pericardial effusion of up to 13 cm with complete compression of the right atrium and ventricle was detected. Emergency placement of a pericardial drain was performed, which relieved a total of 1700 ml of hemorrhagic-purulent fluid over the following days. Methicillin-sensitive Staphylococcus aureus was detected in blood cultures and the puncture fluid. The patient was transferred to our department. We performed pericardial resection and decortication of the heart via right sided thoracotomy, to avoid a sternal infection. The operative course was uneventful. We continued antibiotic therapy according to resistance profile and performed lavage of the pericardium and pleura via the inserted drains for 10 days. The patient was discharged home on the 16th postoperative day. Schlussfolgerung Despite the overall favorable course, pericardial empyema is a dangerous disease with the risk of tamponade and sepsis. Treatment with initial drain of the percardium, consequent antibiotic therapy, and secondary surgical approach with pericardial resection and decortication follow by lavage can be successful. Publication History Article published online: 21 August 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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