Treatment of postoperative MRSA pyothorax. Influence of bronchopleural fistula and residual lung volume.

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The treatment of postoperative pyothorax is troublesome, especially if the organism is methicillin-resistant staphylococcus aureus (MRSA). We report here 9 cases of postoperative MRSA pyothorax.<BR>The initial operations for those patients (lung cancer in 6, trauma in 3) were pneumonectomy in 5, lobectomy in 2, and other surgery in 2. Postoperative MRSA pyothorax was due to bronchopleural fistula (BPF) in 4, open wound infection, retroperitoneal abscess and preoperative lung abscess in 1 each ; the cause was unknown in 2. Treatment of postoperative MRSA pyothorax was : open drainage in 3, omental pedicle flap, open drainage and omental pedicle flap, open drainage and thoracoplasty, thoracoplasty and muscle flaps in 1 each, and thoracic irrigation and drainage in 2. Five patients improved, but 2 patients with BPF died of MRSA infection, and 2 patients are stable under open drainage.<BR>Postoperative MRSA pyothorax can be controlled by BPF closure, obliteration of the thoracic cavity, and antibiotics (VCM, ABK).
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