초록접수 현황
| 20F-211 | 포스터 발표 |
Efficacy of Antibiotic solution with vancomycin in patient with post-pneumonectomy bronchopleural fistula treated by Amplatzer Septal-Occluder device
Soo Jin Lee, Hyo Yeong Ahn, Jeong Su Cho, Yeong Dae Kim, Hoseok I.
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, the Republic of Korea
Purpose : Postpneumonectomy empyema (PPE) is often seen after patients underwent completion pneumonectomy and it is challenging when it is complicated with bronchopleural fistula (BPF).Management of this critically ill patient needs a multidisciplinary approach especially who is not a surgical candidate.
Methods : Considering the condition of the patient, an Amplatzer Septal-Occluder device(Amplatzer) was applied to close the BPF, and the pleural cavity was sterilized by bedside and thoracoscopic irrigation using an antibiotic solution.The concentration of vancomycin in pleural fluid and serum collected 6 hours after an antibiotic solution irrigation was consistently observed by therapeutic-drug monitoring.
Results : MRSA in the pleural effusion disappeared completely from one month after the Amplatzer placement(a bacterial culture test was performed three times, with a result of “no growth”).Finally, the chest tube was removed and the patient was discharged 55 days after Amplatzer placement. In the 6 months after the application of the the device, there were no other complications, and the condition of the patient has been greatly improved.
Conclusion : In immunocompromised patients suffering from PPE with BPF who are unable to undergo surgical management, the application of an Amplatzer device for BPF closure and sterilization using antibiotic solution irrigation may be a safe alternative method to isolate the pleural cavity from contamination and to eradicate the bacterial colonies in pleural cavity, especially in cases with MRSA infection.However, the animal experiments were still lack to prove effect of topically applied antibiotics in pleural cavity.In future, we need to evaluate the pharmacokinetics of topically applied antibiotics in pleural cavity in animals.
Methods : Considering the condition of the patient, an Amplatzer Septal-Occluder device(Amplatzer) was applied to close the BPF, and the pleural cavity was sterilized by bedside and thoracoscopic irrigation using an antibiotic solution.The concentration of vancomycin in pleural fluid and serum collected 6 hours after an antibiotic solution irrigation was consistently observed by therapeutic-drug monitoring.
Results : MRSA in the pleural effusion disappeared completely from one month after the Amplatzer placement(a bacterial culture test was performed three times, with a result of “no growth”).Finally, the chest tube was removed and the patient was discharged 55 days after Amplatzer placement. In the 6 months after the application of the the device, there were no other complications, and the condition of the patient has been greatly improved.
Conclusion : In immunocompromised patients suffering from PPE with BPF who are unable to undergo surgical management, the application of an Amplatzer device for BPF closure and sterilization using antibiotic solution irrigation may be a safe alternative method to isolate the pleural cavity from contamination and to eradicate the bacterial colonies in pleural cavity, especially in cases with MRSA infection.However, the animal experiments were still lack to prove effect of topically applied antibiotics in pleural cavity.In future, we need to evaluate the pharmacokinetics of topically applied antibiotics in pleural cavity in animals.
첨부파일 : figure legend.docx
책임저자: Hyo Yeong Ahn
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Medical Research Institution, Busan, the Republic of Korea
발표자: Soo Jin Lee, E-mail : sjl4401@nate.com