Purulent pericarditis complicating coronary artery bypass

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Critical Care

Background:

• Purulent pericarditis is a rare but serious complication following cardiac surgery.
• Differentiating it from postpericardiotomy syndrome is critical for appropriate management.
• The increasing use of prophylactic antibiotics may alter the causative organisms.

Observation:

• A patient developed fever and pericardial effusion post-coronary artery bypass surgery.
• Pericardiocentesis was performed, confirming purulent pericarditis.
• The causative agent was identified as an aerobic gram-negative bacillus, Proteus.

Findings:

• This represents the first reported survivor of Proteus purulent pericarditis after coronary artery bypass.
• Prompt diagnosis through pericardiocentesis is essential.
• Aerobic gram-negative bacilli are potential pathogens in postoperative purulent pericarditis.

Implications:

• Highlights the importance of considering purulent pericarditis in febrile patients with pericardial effusion after bypass.
• Emphasizes the need for prompt diagnostic and therapeutic interventions, including surgical drainage and targeted antibiotics.
• Suggests a potential shift in causative pathogens for postoperative pericarditis due to antibiotic prophylaxis.