Abstract Pseudomonas aeruginosa accounts for 7.1-7.3% of all healthcare-associated infections, most commonly pneumonia2 with the major virulence factor of P. aeruginosa is exotoxin-S (ExoS) inducing cytotoxic damage especially in patients who are immunocompromised or have damaged epithelium. Disruption of epithelial barriers increases vascular permeability and allows bacterial invasion into the pleural space resulting in parapneumonic effusion that may progress to empyema if untreated3. Pseudomonas empyema is a rare complication seen in about 4-8% of pseudomonal VAP and HAP cases2,3. While the specific mortality for P. aeruginosa empyema is not fully established, pseudomonal pneumonia carries a mortality rate of about 30.9%4 necessitating prompt treatment. Management requires drainage and at least 2 weeks of antipseudomonal antibiotics3. Given its rarity yet highly associated mortality, early recognition and aggressive management of P. aeruginosa empyema is important to improving patient outcomes. This is a case report of a male in his 50’s who had weakness, shortness of breath and fatigue and was noted to have MRSA bacteremia with suspected ifective endocarditis complicated by rupture of mycotic aneurysm/septic emboli infarcting the right frontal and right parieto-occipital lacunar regions. He also had pneumonia noted on CT with hydropneumothorax. Thoracostomy retrieved purulent fluid that grew pseudomonas aeruginosa. TPA-dornase was utilized to aid in drainage as he was a poor surgical candidate. He did not have complete clearance of the empyema and was discharged with a chest tube for intermittent drainage as an outpatient and continuation of meropenem for a three-week course. Interestingly, he had a chest tube inserted prior to this admission for drainage of an empyema that was recurring noted by nucleated cells about 1700 with 98 neutrophils and 2000 red blood cells glucose 20 and LDH 2500. His pleural fluid grew both MRSA and pseudomonas in the 8 months that he was being treated. He did ultimately have clearance of the organisms with aggressive, prolonged treatment and drainage. This abstract is funded by: None
Alsheimer et al. (Fri,) studied this question.