冠動脈バイパス術後MRSA感染によるグラフト破裂の1例

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  • RUPTURE OF A MRSA (METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS) INFECTED VEIN GRAFT FOLLOWING AN AORTOCORONARY BYPASS SURGERY -REPORT OF A CASE-

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We experienced a case of mediastinitis due to methicilline-resistant Staphylococcus aureus (MRSA) causing rupture of vein graft following an aortocoronary bypass surgery.<br> A 74-year-old man was admitted to the hospital because of a chest pain. Coronary angiography revealed 90% stenosis of the right coronary artery (segment 1), 80% stenosis of the anterior descending branch of the left coronary artery (segment 7), and complete obstruction of the left circumflex branch of the coronary artery. Using a graft made from the great saphenous vein, an aortocoronary bypass operation was carried out. Postoperative course was uneventful, but MRSA mediastinitis developed 4 days after the bypass surgery. He was initially treated with antibiotics. However, 10 days after the bypass surgery, massive bleeding occurred from a drainage tube and he went into shock. An emergency operation revealed that massive bleeding occurred due to the rupture of an infected vein graft to the LAD. Twelve days later, massive bleeding from the drainage tube occurred again. Another emergency operation having a cardiac massage revealed the rupture of an infected vein graft of the RCA. Suture ligation of these vein grafts was successfully performed.<br> Fifteen days later, unfortunately, we lost him due to massive bleeding. Rupture of the heart or vessels due to mediastinitis following open heart surgery is very rare, but it has a high mortality. It is imperative to systematize the teamwork of the infection control doctors and infection control nurses as specialists or other medical staffs as well as to eradicate the infection as much as possible in order to prevent the hospital infection.

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