Purulent Pericarditis: Treating a Medically-Complex Patient With Intrapericardial Antibiotics

OBJECTIVE: Purulent pericarditis is a rare, lethal complication of a bacterial pericardial infection. This case report outlines the protocol for instilling intrapericardial antibiotics for methicillin-sensitive Staphylococcus aureus (MSSA) pericarditis without fibrinolytics in a 51-year-old man. KEY STEPS: An appropriately sized percutaneous pericardial drain was placed. Then, a 3-day course of intrapericardial infusions of 50 mL vancomycin was begun. Drainage of all accessible fluid was performed before each infusion. The daily infusions each had an 8-hour dwell time. The prior drainage protocol continued after each infusion. POTENTIAL PITFALLS: Strict dosage and infusion length management are required to prevent direct toxicity. Potential complications include local inflammatory responses and constrictive pericarditis. TAKE-HOME MESSAGES: The use of simultaneous intravenous and intrapericardial antibiotics were used for treating MSSA purulent pericarditis without using intrapericardial fibrinolytics in an adult. This was noted to favorably improve the purulent output and relative safety without untoward complications.