Novel management of pseudomonas biofilm-like structure in a post-pneumonectomy empyema.
Gustafson, Alexandra M;
Larrain, Carolina M;
Friedman, Lindsay R;
Repkorwich, Rachel;
Anidi, Ifeanyichukwu U;
Forrest, Karen M;
Fennelly, Kevin P;
Carr, Shamus R;
(2024)
Novel management of pseudomonas biofilm-like structure in a post-pneumonectomy empyema.
Frontiers in cellular and infection microbiology, 14.
1458652-.
ISSN 2235-2988
DOI: https://doi.org/10.3389/fcimb.2024.1458652
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
We present a patient with a post-pneumonectomy empyema refractory to surgical debridement and systemic antibiotics. The patient initially presented with a bronchopleural fistula and pneumothorax secondary to tuberculosis (TB) destroyed lung, which required a pneumonectomy with Eloesser flap. Ongoing pleural infection delayed the closure of the Eloesser flap, and thoracoscopic inspection of his chest cavity revealed a green, mucous biofilm-like structure lining the postpneumonectomy pleural cavity. Cultures identified pan-susceptible Pseudomonas aeruginosa. Despite debriding this biofilm-like structure and administering systemic antibiotics, the patient continued to show persistent signs of infection and regrowth of the film. We employed a novel approach to dissolve the biofilm-like structure using intrapleural dornase alfa followed by intrapleural antibiotic washes. After 3 weeks of daily washes, repeat inspection demonstrated the biofilm-like structure had completely resolved. Resolving the pseudomonas biofilm-like structure allowed permanent closure of his chest without further need for systemic antibiotics. At follow up 3 months later, he showed no sequalae. This treatment option can be an important adjunct to improve likelihood of chest closure in patients with post-pneumonectomy empyema that resists standard treatment options due to biofilm formation.