Mediastinitis due to Nocardia asteroides after cardiac transplantation

• Published in: Intensive care medicine Vol. 18; no. 2; p. 127
• Main Authors: Thaler, F, Gotainer, B, Teodori, G, Dubois, C, Loirat, P
• Format: Journal Article
• Language: English
• Published: United States 1992
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Carbohydrates - therapeutic use; Cyclosporins - adverse effects; Debridement; Drug Interactions; Heart Transplantation; Humans; Immunosuppression - adverse effects; Mediastinitis - etiology; Mediastinitis - microbiology; Mediastinitis - therapy; Nocardia asteroides; Nocardia Infections - etiology; Nocardia Infections - microbiology; Nocardia Infections - therapy; Surgical Wound Infection - etiology; Surgical Wound Infection - microbiology; Surgical Wound Infection - therapy
• ISSN: 0342-4642
• DOI: 10.1007/BF01705048

Nocardia infection classically occurs in immuno-compromized patients. Only a few cases of mediastinal infection due to this pathogen have been described in the literature. We report a patient who developed mediastinitis due to Nocardia asteroides after cardiac transplantation. The treatment was surgical debridement, dressing, sugaring and antibiotic therapy. The emergence of a severe acute renal failure possibly induced by drug interaction between Cyclosporin, cyclines and aminoglycosides, led us to modify the antimicrobial treatment. The intravenous use of Imipenem 2 g per day and Ciprofloxacin 400 mg per day for four weeks and then oral Ciprofloxacin 1.5 g per day for 1 year, was effective and allowed a good outcome, without any drug interaction with Cyclosporin, adverse effect, graft rejection episode or infection relapse.