Topical sevoflurane and healing of a post-operative surgical site superinfected by multi-drug-resistant Pseudomonas aeruginosa and susceptible Staphylococcus aureus in an immunocompromised patient.

BACKGROUND: Infections caused by multi-drug-resistant organisms are too common and represent a therapeutic challenge. Topical application of sevoflurane may be useful for the treatment of cutaneous infections, as this general anesthetic has antimicrobial properties in vitro. CASE REPORT: A 43-year-old male patient received a liver transplant because of cirrhosis caused by hepatitis C. The surgical site was infected initially by multi-drug-resistant Pseudomonas aeruginosa that was susceptible to colistin, but parenteral administration of this antibiotic led to deterioration of renal function and was discontinued. The incision did not heal with daily lavage and debridement and was superinfected with Staphylococcus aureus. The off-label use of liquid sevoflurane in the form of site irrigations was followed by healing and closure of the site. This healing could be attributable to the mixed effect of three possible actions of sevoflurane: Direct antimicrobial effect, local analgesic effect that improved the quality of the dressings, and a direct vasodilator effect that, in theory, increased the supply of nutrients to the incision bed.
CONCLUSIONS: The use of liquid sevoflurane on sites infected by microorganisms resistant to conventional antibiotics appears to be an attractive therapeutic option that deserves future research.