[Coronary stent infection: case report and definition].

A low incidence of coronary stent infections has been described in literature, although severe complications such as purulent pericarditis and endarteritis, have been reported. Currently, infection definition criteria or protocolized clinical strategies do not exist. Therefore, we report a case of coronary stent infection associated with pericarditis and we review similar cases in the literature. We present the case of a 55 years old male with diabetes type 2 and a history of AMI. Coronary angiography, was performed due to post-AMI angina, and evidenced total occlu-sion of the right coronary artery. Ten days later, the patient underwent a rotablator assisted angioplasty and implantation of a 26 mm Jostent Flex stent mounted on a 3.5-25 mm Cros-sail balloon. This procedure lasted 3 hours using a JR 3.5 guiding catheter (Cordis) 7 French, and Valor balloons (Cordis) of 1.5-20 mm and Crossail (Guidant) of 2.0-20, 3.0-20 and 3.5-25 mm. The catheter sheath was removed after 4 h. The day after, the patient presented fever from undeter-mined origin during 24 h. Two weeks later, fever and chest pain reappeared, while pericardial rub was found in the physical examination, as well as pericardial effusion in the 2D echocardiographic examination. The patient was admitted to the hospital, three blood cultures were drawn, and cephalothin and gentamicin therapy was initiated due to suspected acute pericarditis. A transesophagic echocardiographic examination (TEE) revealed an image in the aortic valve suggestive of a vegetation. The patients remained with fever, pericardial rub and diffuse ST elevation, and blood cultures were negative; cephalothin was replaced by vancomycin on the fourth day, after two additional blood cultures. Ten days after, one blood culture was positive for Candida spp. Amphotericin B was added to therapy and the patient remained symptomatic after 15 days; a second TEE did not disclose significant changes with respect to the first. The patient was referred for surgery due to the absence of clinical solutions; during surgery a nod-ule on the aortic valve was resected and infectious endocardi-tis was excluded by pathology report. Partial pericardiectomy was performed due to pericardial thickening, with a pathology report compatible with unspecified chronic pericarditis. A ve-nous bypass to the right coronary artery and posterior ventric-ular branch was also performed, as well as the removal of the coronary artery-stent complex. Explanted surgical materials were sent for culture, and coagulase-negative oxaciline-resistant staphylococci (CNRS) was identified in all the samples. Postoperatory evolved stable with fever, with …