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Perfusionist-transmitted bacterial mediastinitis in a heart transplant recipient
1Department of Surgery, National Taiwan University Hospital, Taipei, Republic of China.
Abstract:
We report the case of a 56-year-old man who developed bacterial mediastinitis with methicillin-resistant Staphylococcus aureus after undergoing heart transplantation. He had a history of insulin-dependent diabetes mellitus and prior cardiac surgery. To find the source of nosocomial infection, we cultured nasal swab specimens from all hospital personnel involved in this operation. We used antibiotic sensitivity profiling and pulsed-field gel electrophoresis to subtype the involved microorganism. The S. aureus isolates from the patient and the perfusionist were identical to each other and were different from the strains previously found in our hospital. It is almost certain that the S. aureus mediastinitis in this patient was transmitted from the perfusionist. We recommend obtaining cultures from hospital staff members when there is an outbreak of staphylococcal infection.
Insights
A heart transplant patient developed methicillin-resistant Staphylococcus aureus mediastinitis. The infection was traced to a perfusionist, highlighting the importance of staff screening during outbreaks.
Area of Science:
- Infectious Diseases
- Transplantation Surgery
- Microbiology
Background:
- Bacterial mediastinitis is a serious complication following cardiac surgery, particularly in immunocompromised patients.
- Heart transplantation recipients are at increased risk for nosocomial infections due to immunosuppression.
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings.
Observation:
- A 56-year-old male heart transplant recipient developed MRSA mediastinitis.
- Nasal swabs from operating personnel were cultured to identify the infection source.
- The MRSA strain from the patient matched the strain found in a perfusionist.
Findings:
- Pulsed-field gel electrophoresis confirmed the isolates from the patient and perfusionist were identical.
- The identified MRSA strain was unique and not previously prevalent in the hospital.
- Transmission of MRSA from the perfusionist to the patient was the likely cause of mediastinitis.
Implications:
- Healthcare facilities should consider culturing hospital staff during staphylococcal infection outbreaks.
- This case underscores the critical need for vigilant infection control in transplant surgery.
- Identifying and controlling sources of nosocomial infections is paramount in patient safety.