A case of MRSA empyema with fistula and nephritic syndrome successfully treated with detergent using 0.1% pyoktanin solution

• Published in: The Journal of the Japanese Association for Chest Surgery Vol. 30; no. 2; pp. 159 - 163
• Main Authors: Naomi, Akira, Oyamatsu, Hironori, Narita, Kunio
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Association for Chest Surgery 15.03.2016
• Subjects: lastissimus dorsi muscle flap plombage; MRSA empyema with fistula; nephrotic syndrome; pyoktanin solution detergent
• ISSN: 0919-0945; 1881-4158
• DOI: 10.2995/jacsurg.30.159

A 39-year man was administered methyl prednisolone due to exacerbation of nephritic syndrome. After a few days, he developed right empyema with a fistula, and therefore we subsequently performed open window thoracostomy for infection control. However, on the 15th post-operative day (POD), MRSA was detected by microbial culture in the pleural cavity and wound. We exchanged the intrathoracic gauze to sterilize MRSA, and then the right middle and lower lung lobes were expanded sufficiently to perform muscle flap plombage and reduce the dead intrathoracic cavity. We performed latissimus dorsi muscle flap plombage for dead space closure in the thoracic cavity. A few days later, his wound was infected by MRSA, and we tried to eradicate MRSA by washing the wound and thoracic cavity with saline, but failed to sterilize it. We then cleaned the wound using methylrosanilin chloride, having a bactericidal effect at a concentration of 0.1%. On the 13th day of using pyoktanin solution, we succeeded in eradicating MRSA from the thoracic cavity and wound without aspiration pneumonia, and then sutured and perfomed debridment of his wound. He was discharged a few days after wound closure. We suggest that it is effective to sterilize MRSA-infected wounds and cavity infections using pyoktanin solution at a concentration of 0.1%.