Management of Stenotrophomonas mediastinitis after heart transplantation for persistent driveline infection: a case report

TL;DR

A heart transplant patient with a persistent driveline infection developed mediastinitis caused by Stenotrophomonas maltophilia, requiring aggressive surgical and antibiotic treatment for recovery.

Contribution

Highlights the risk of mediastinitis from unresolved driveline infections post-transplant and presents an effective treatment strategy.

Findings

Persistent driveline infection led to mediastinitis caused by Stenotrophomonas maltophilia after heart transplantation.

Aggressive surgical interventions and extended antibiotic therapy successfully managed the infection.

Immunosuppressed status and driveline infections increase the risk of severe post-transplant complications.

Abstract

We report a 62-year-old male who had a Heartware left ventricular assist device (LVAD) implantation and subsequently developed a persistent driveline infection, culminating in an abscess along the driveline site despite 18 months of antibiotic treatment. His situation was further complicated post-transplant by the onset of mediastinitis, linked to a previously undervalued Stenotrophomonas maltophilia infection. This report highlights the potential risks of heart transplantation in patients with unresolved LVAD driveline infections, particularly mediastinitis. The presence of existing driveline infections, combined with the immunosuppressed status of patients, necessitates aggressive surgical measures. Our treatment approach, involving multiple mediastinal washouts, omental flap use, antibiotic bead placement, and an extended post-discharge antibiotic regimen, led to a successful patient outcome. The case emphasizes the importance of thorough antimicrobial coverage for all identified pathogens post-transplantation and advocates for aggressive surgical intervention in managing postoperative complications associated with LVAD driveline infections.

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