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Intrapleural Gentian Violet Irrigation for Refractory Methicillin-Resistant Staphylococcus aureus Empyema: A Case
Yasoo Sugiura1, Hiroyuki Fujimoto1, Yoshihiko Morikawa2
1Department of General Thoracic Surgery National Hospital Organization, Kanagawa Hospital Hadano City Kanagawa Japan.
Abstract:
Methicillin-resistant Staphylococcus aureus (MRSA) empyema remains challenging despite guideline-based management. Gentian violet (GV), an antiseptic dye, has been sporadically used for MRSA infections but not systematically evaluated in pleural disease. We analysed nine consecutive patients with MRSA empyema treated with intrapleural GV irrigation following surgical debridement between 2011 and 2018. All patients successfully completed GV irrigation without procedural complications. Bacterial clearance was achieved within a median of 5 days (IQR, 4-8), which was within the range observed in the non-MRSA cohort treated with saline lavage (13 days [IQR, 6-24]). No GV-related adverse events occurred during a median follow-up of 993 days. Three patients developed Pseudomonas aeruginosa superinfection, likely reflecting GV's limited Gram-negative activity. This case series demonstrates that intrapleural GV irrigation is feasible and safe, achieving microbiological clearance within an acceptable timeframe for MRSA empyema.
Insights
Gentian violet (GV) irrigation offers a safe and feasible treatment for Methicillin-resistant Staphylococcus aureus (MRSA) empyema. This method achieved bacterial clearance faster than traditional saline lavage in a small patient group.
Area of Science:
- Infectious Diseases
- Pulmonology
- Antimicrobial Therapy
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) empyema presents significant treatment challenges.
- Gentian violet (GV), an antiseptic, has limited evaluation in pleural infections.
Purpose of the Study:
- To assess the feasibility, safety, and efficacy of intrapleural Gentian violet (GV) irrigation for MRSA empyema.
Main Methods:
- A case series of nine patients with MRSA empyema treated with intrapleural GV irrigation post-surgical debridement.
- Evaluation of procedural complications, bacterial clearance time, and adverse events during follow-up.
Main Results:
- All nine patients completed GV irrigation without complications.
- Median bacterial clearance was 5 days, faster than the saline lavage control group (13 days).
- No GV-related adverse events were observed; however, three patients developed Pseudomonas aeruginosa superinfections.
Conclusions:
- Intrapleural GV irrigation is a feasible and safe adjunctive treatment for MRSA empyema.
- GV irrigation achieves timely microbiological clearance.
- GV has limited activity against Gram-negative bacteria, necessitating vigilance for superinfections.
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