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Invasive Staphylococcal Infections Complicating Percutaneous Transluminal Coronary Angioplasty

1996; Oxford University Press; Volume: 22; Issue: 3 Linguagem: Inglês

10.1093/clinids/22.3.601

1537-6591

K. W. Shea, B. A. Cunha,

Infective Endocarditis Diagnosis and Management

Transluminal Coronary Angioplasty SIR-Cleveland and Gelfand recently reviewed invasive staphylococcal infections complicating percutaneous transluminal coronary angioplasty (PTCA) [1].Recently, during a prospective investigation of bacteremia associated with PTCA at our institution [2], we noted a similar case of femoral endarteritis and an infected pseudoaneurysm due to Staphylococcus aureus.A 78-year-old obese woman with a history ofnon-insulin-dependent diabetes mellitus and hypothyroidism was admitted to the hospital with complaints of left-sided chest and shoulder pain.Diagnostic cardiac catheterization was performed that revealed 90% stenosis ofthe left anterior descending artery.The right femoral artery sheath was left in place, and PTCA was performed 22 hours later.The procedure was well tolerated, and the femoral sheath was removed 23 hours later.The patient complained of pain in the right groin 1 hour after removal of the sheath, but examination revealed only mild ecchymosis without evidence of hematoma or drainage.Six hours after removal of the sheath, her temperature spiked to 103.6°F.The WBC count was l6,700/mm 3• Treatment with vancomycin (1 g iv every 12 hours) was started because she was allergic to penicillin.Three sets of blood cultures performed at the time of the initial temperature spike yielded S. aureus.Because the ecchymosis had increased in size, duplex ultrasonography of the right groin was performed and revealed a small hematoma.No pseudoaneurysm was noted.Six days following PTCA, purulent drainage and overlying cellulits developed at the right groin site.The patient's fever persisted, and aztreonam (2 g iv every 8 hours) was added empirically to the therapeutic regimen.A CT scan did not reveal any focal collection in the right groin.Cultures of the purulent exudate yielded S. aureus, Proteus mirabilis, and enterococci, and repeated blood cultures were positive for S. aureus.Despite local incision and drainage, the patient's right foot became cool and mottled, and several purpuric lesions appeared