Table 1 Clinical data of 4 patients with recognised purulent pericarditis
From: Intrapericardial recombinant tissue plasminogen activator in purulent pericarditis- case series
Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
Sex | male | female | male | male |
Age | 27 | 50 | 69 | 63 |
Predisposingfactors | common variable immunodeficiency left-sided pneumonia empyema sepsis CMV infection | not identified | not identified | bacterial inflammation of the knee-joint |
Responsible pathogen | Streptococcus pneumoniae | Staphylococcus epidermidis | not identified | Staphylococcus aureus |
Indications for intrapericardial fibrinolytic treatment | echocardiographic features of early constriction | a large amount of fibrin in the pericardium with fluid loculations | echocardiographic features of early constriction | large pericardial drainage |
Type of intrapericardial treatment | r-tPA (Actylise) 20 mg/100 ml 0,9% NaCl clamped tube for 24 h | r-tPA (Actylise) 20 mg/ 100 ml 0,9% NaCl clamped tube for 24 h | r-tPA (Actylise) 20 mg /100 ml 0,9%NaCl clamped tube for 24 h | 17 days after Streptokinase administration (ineffective) |
r-tPA (Actylise) 20 mg/100 ml 0,9% NaCl clamped tube for 24 h | ||||
Number of r-tPA doses | 1 | 2 | 1 | 2 |
Indications for repeated intrapericardial fibrinolytic treatment | – | a large amount of fibrin in the pericardium with fluid loculations | – | large pericardial drainage |
echocardiographic features of early constriction | ||||
Type of repeated intrapericardial treatment | – | r-tPA (Actylise) 20 mg/ 100 ml 0,9% NaCl clamped tube for 24 h | – | r-tPA (Actylise) 20 mg/ 50 ml 0,9% NaCl clamped tube for 24 h |
Local complications of intrapericardial fibrinolytic treatment | – | extensive leak of pericardial fluid next to the drain after first r-tPA dose | – | – |
General complications | not observed | not observed | not observed | not observed |
Inflammatory biomarkers | ||||
CRP mg/l | 269 | 27 | 231 | 292 |
WBC [x10̂9/l | 36 | 20 | 13,5 | 15 |
Procalcitonin ng/ml | 1,75 | no data | no data | no data |
Intravenous antibiotics doses/days | ||||
Meropenem/3 × 1,0 g/15 days | Ceftriaxon/1 × 2,0 g/5 days | Piperacillin/Tazobactam/3 × 4,5 g/ 28 days | Piperacillin/ Tazobactam/3 × 4,5 g/21 days | |
Vancomycin3x1,0 g/13 days | Clarithromycin/2 × 500 mg/22 days | Levofloxacin/2x500mg/28 days | Ciprofloxacin/2 × 200 mg/ 8 days | |
Colistin/3x2mlnIU/11 days | Doxycycline/1x100mg/35 days | Amikacin/2x500mg/28 days | Linezolid/2 × 600 mg/13 days | |
Clindamycin/3 × 600 mg/8 days | Augmentin/3 × 1,2 g/ 24 days | |||
Metronidazole/ 3x250mg/9 days | ||||
Ganciclovir/2x200mg/13 days | ||||
Length of drainage | 29 days | 19 days | 17 days | 32 days |
Time from intrapericardial r-tPA to the drain removal | 8 days | 6 days after the second r-tPA dose | 8 days | 6 days after the second r-tPA dose |