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Clinical Presentation and Management of Methicillin-Resistant Staphylococcus aureus Pericarditis-Systematic Review

Milan Radovanovic1,2, Marija Petrovic3, Richard D Hanna1,4

  • 1Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA.

Journal of Cardiovascular Development and Disease
|April 21, 2022
PubMed

Insights

Methicillin-resistant Staphylococcus aureus (MRSA) pericarditis often presents with sepsis and carries a high mortality rate, particularly in adults. Early diagnosis via echocardiography and pericardiocentesis is crucial for effective treatment.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Medical Microbiology

Background:

  • Antibiotic resistance is a growing global health concern, with Methicillin-resistant Staphylococcus aureus (MRSA) posing a significant threat.
  • MRSA strains have emerged with resistance to conventional antibiotics, complicating treatment strategies.
  • Pericarditis, inflammation of the pericardium, can be life-threatening, especially when caused by resistant pathogens.

Purpose of the Study:

  • To systematically review and synthesize information on previously documented cases of MRSA pericarditis.
  • To analyze clinical characteristics, treatment outcomes, and mortality associated with MRSA pericarditis.
  • To highlight the importance of early diagnosis and intervention for MRSA pericarditis.

Main Methods:

  • Systematic literature review including only cases with MRSA isolated from the pericardial space.
  • Inclusion of 30 adult and 9 pediatric patients.
  • Analysis of patient demographics, comorbidities, clinical presentation, diagnostic methods, treatment, and outcomes.

Main Results:

  • Pericardial effusion occurred in 94.9% of cases, with tamponade in 83.8%.
  • MRSA was isolated from pericardial fluid in all cases; 64.1% had positive blood cultures.
  • Adults had a 20.5% mortality rate, attributed to septic shock and multi-organ failure; no pediatric mortality was observed.

Conclusions:

  • MRSA pericarditis is frequently associated with sepsis and carries a substantial mortality risk in adults.
  • High clinical suspicion, echocardiography, and pericardiocentesis are essential for timely diagnosis and management.
  • MRSA pericarditis can occur without documented bacteremia in over one-third of cases, underscoring the need for direct pericardial fluid analysis.
Keywords:
MRSAbacterial pericarditismethicillin-resistant Staphylococcus aureuspurulent pericarditis

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