meropenem and Endocarditis--Bacterial

With the development of invasive medical procedures, an increasing number of healthcare-associated infective endocarditis cases have been reported. In particular, non-nosocomial healthcare-associated infective endocarditis in outpatients with recent medical intervention has been increasingly identified.. A 66-year-old man with diabetes mellitus and a recent history of intermittent urethral self-catheterization was admitted due to a high fever. Repeated blood cultures identified Pseudomonas aeruginosa, and transesophageal echocardiography uncovered a new-onset severe aortic regurgitation along with a vegetative valvular structure. The patient underwent emergency aortic valve replacement surgery and was successfully treated with 6 weeks of high-dose meropenem and tobramycin. Historically, most cases of P. aeruginosa endocarditis have occurred in the right side of the heart and in outpatients with a history of intravenous drug abuse. In the case presented, the repeated manipulations of the urethra may have triggered the infection. Our literature review for left-sided P. aeruginosa endocarditis showed that non-nosocomial infection accounted for nearly half of the cases and resulted in fatal outcomes as often as nosocomial cases. A combination therapy with anti-pseudomonal beta-lactams or carbapenems and aminoglycosides may be the preferable treatment. Medical treatment alone may be effective, and surgical treatment should be carefully considered.. We presented a rare case of native aortic valve endocarditis caused by P. aeruginosa. This case illustrates the importance of identifying the causative pathogen(s), especially for outpatients with a recent history of medical procedures.

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis; Endocarditis, Bacterial; Foramen Ovale, Patent; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Intermittent Urethral Catheterization; Magnetic Resonance Imaging; Male; Meropenem; Pseudomonas aeruginosa; Pseudomonas Infections; Thienamycins; Tobramycin; Ultrasonography, Doppler

Whipple's disease is a multisystemic infection caused by the ubiquitous bacterium Tropheryma whipplei. Immunological host factors enable classical Whipple's disease; however, T. whipplei can be found in three other clinical conditions: healthy colonization, self-limiting infections, and isolated endocarditis. The genetic predisposition of the host rather than the genotype of the bacterium influences the infection. Modern diagnostic methods elucidate the many facets of Whipple's disease. In particular, isolated T. whipplei-induced infective endocarditis can only be diagnosed after valve resection. The sole treatment of Whipple's disease evaluated prospectively comprises intravenous induction therapy with ceftriaxone or meropenem, followed by continuation therapy with oral TMP-SMX. In the case of Immune reconstitution inflammatory syndrome (IRIS) or inflammatory lesions of the CNS in the setting of Whipple's disease, additional treatment with corticosteroids should be considered to avoid severe tissue damage.

Topics: Adrenal Cortex Hormones; Adult; Algorithms; Anti-Bacterial Agents; Biopsy; Carrier State; Ceftriaxone; Central Nervous System Diseases; Child; Diagnosis, Differential; Drug Therapy, Combination; Duodenum; Endocarditis, Bacterial; Gastroscopy; Genetic Predisposition to Disease; Heart Valves; Humans; Immune Reconstitution Inflammatory Syndrome; Meropenem; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

A rare case of prosthetic valve endocarditis from Acinetobacter spp occurring 9 months postoperatively is described. The patient initially received empirical therapy against pathogens commonly associated with prosthetic valve endocarditis, but his condition did not improve. Identification of bacteremia due to Acinetobacter spp was not attributed to any of the classic nosocomial factors such as presence of a catheter or a recent invasive procedure. The patient did well with an intravenous regimen of meropenem and tobramycin instituted according to susceptibility testing. Physicians should be aware of this rare association of a nosocomial pathogen such as Acinetobacter spp with prosthetic valve endocarditis occurring long after the initial cardiothoracic procedure.

Topics: Acinetobacter; Acinetobacter Infections; Aged; Anti-Bacterial Agents; Cross Infection; Echocardiography, Transesophageal; Endocarditis, Bacterial; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Meropenem; Reoperation; Thienamycins; Tobramycin

A 49-year-old man presented with fever and uremic symptoms such as general malaise, leg edema and decreased urine output. He was diagnosed as having infective endocarditis (IE) accompanied by renal failure. Although he had been receiving hemodialysis for a long time, renal function dramatically improved after heart valve replacement. This case suggests that uremia can develop as an initial manifestation of IE and removal of an infected heart valve can improve renal function despite persistent renal failure. From the perspective of recovery of renal function, early surgery should be considered in patients with renal failure following IE.

Topics: Anuria; Aortic Valve; Diagnosis, Differential; Echocardiography, Doppler; Endocarditis, Bacterial; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Male; Meropenem; Middle Aged; Thienamycins; Uremia

Medical treatment alone is rarely successful in left-sided infective endocarditis caused by Pseudomonas aeruginosa. We report the cure of such a case with high-dose meropenem in combination with tobramycin.

Topics: Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Meropenem; Pseudomonas aeruginosa; Pseudomonas Infections; Thienamycins; Tobramycin

Described here is the case of a patient with infective endocarditis in a prosthetic valve due to a Mycobacterium fortuitum-group organism. The patient was treated medically and had a favorable clinical response. This is only the second report of survival after Mycobacterium fortuitum-group endocarditis, and the first of survival without surgical intervention. The duration of treatment is not well defined for this patient, but life-long suppressive therapy will likely be required.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Ciprofloxacin; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Meropenem; Mycobacterium fortuitum; Mycobacterium Infections; Prosthesis-Related Infections; Thienamycins

BACKGROUND We report 2 cases of recurrent right-sided endocarditis in 2 young patients known to be intravenous (i.v.) drug users. We highlight the importance of early diagnosis and management, especially in recurrent infection, which has a higher mortality rate and poor prognostic outcome despite antibiotic treatment. CASE REPORT A 30-year-old woman with a medical history of active i.v. drug use and tricuspid valve replacement owing to Serratia marcescens endocarditis 2 months prior to presentation was admitted to the Intensive Care Unit for septic shock. The patient did not respond to i.v. fluids and required vasopressors. Blood cultures returned positive for S. marcescens again. The antibiotic regimen consisted of meropenem and vancomycin. The patient underwent redo sternotomy, explant of old tricuspid valve bioprosthesis, debridement of tricuspid valve annulus, and bioprosthetic valve replacement. She continued antibiotic treatment during hospital admission for 6 weeks. In another similar case, a 30-year-old woman, also an i.v. drug user, was admitted to the hospital for tricuspid bioprosthetic valve S. marcescens endocarditis after tricuspid valve replacement 5 months prior to her presentation with S. marcescens endocarditis. Her antibiotic regimen consisted of meropenem and vancomycin. She was eventually transferred to a tertiary cardiovascular surgery center for further case management. CONCLUSIONS In the setting of recurrent bioprosthetic valve S. marcescens endocarditis, it is suggested that treatment should be more focused on source control, including cessation of i.v. drug abuse and providing appropriate antibiotic treatment to prevent recurrence because, in the case of recurrence, morbidity and mortality risk can increase significantly.

Topics: Adult; Anti-Bacterial Agents; Drug Users; Endocarditis; Endocarditis, Bacterial; Female; Humans; Meropenem; Serratia marcescens; Substance Abuse, Intravenous; Vancomycin

A 17-year-old woman was admitted to our hospital because of a high fever, consciousness disturbance, and delirious behavior. Methicillin susceptible Staphylococcus aureus (MSSA) infection was confirmed by blood culture. Transthoracic echocardiogram showed no abnormality at first. Diffusion-weighted brain MRI showed a high intensity lesion in the middle portion of the splenium, which was shown as low intensity on apparent diffusion coefficient map. Then, antibiotics therapy was started against suspected bacterial meningitis, while the lumbar puncture was not performed because of the decreased number of platelets. Since the systolic murmur appeared at the apex on day 12, the diagnosis with infectious endocarditis was made by transthoracic echocardiogram. The MRI abnormalities disappeared on day 16 and we diagnosed her with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with infectious endocarditis. This case suggests that MERS can occur associated with infectious endocarditis caused by Staphylococcus aureus.

Topics: Adolescent; Anti-Bacterial Agents; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Female; Humans; Infectious Encephalitis; Meropenem; Mitral Valve Annuloplasty; Severity of Illness Index; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin

In Denmark, Q fever has previously been considered a rare and imported disease; however, recent testing of antibodies in cattle as well as humans has indicated that the infection is widespread. A 76-year-old Danish man was diagnosed with infective endocarditis and underwent open surgical aortic valve replacement with insertion of a biological valve. Due to paravalvular leakage, destruction of the aortic annulus, and an aortic root abscess, the patient underwent re-operation 3 weeks later, with replacement of the biological valve and insertion of an aortic prosthetic tube. Despite treatment with various broad-spectrum antibiotic regimes, the patient died 3.5 months after initial hospital admission.. The causative agent was probed by PCR amplification of bacterial DNA on the removed prosthetic aortic valve using broad range primers targeting the variable regions V1-V3 of the 16S RNA gene. After identification of Coxiella burnetii, multispacer sequence typing (MST) was performed by PCR amplification of 10 intergenic sequences.. BLAST analysis of DNA from prosthetic valve material identified a 16S rRNA gene fragment almost identical to the type strain of C. burnetii (462/463 nt). Molecular typing allocated the strain to MST_18.. Molecular methods are increasingly used to characterize isolates and to determine relationships between isolates that cause disease in different contexts and geographical areas. The present case demonstrates that identification and typing of C. burnetii is achievable without access to biosafety level 3 containment and highlights the first molecular characterization of an uncultured strain of C. burnetii causing infective endocarditis.

Topics: Abscess; Aged; Aortic Valve; Coxiella burnetii; Denmark; DNA, Bacterial; Doxycycline; Echinocandins; Endocarditis, Bacterial; Fatal Outcome; Gentamicins; Heart Valve Prosthesis; Humans; Male; Meropenem; Metronidazole; Multilocus Sequence Typing; Rifampin; RNA, Ribosomal, 16S; Vancomycin

Central venous catheter-associated bacteraemia caused by Nocardia species is very rare; the diagnosis of nocardiosis in patients with cancer is challenging because its clinical presentation is varied, sometimes mimicking metastases, and the high index of clinical suspicion is required for prompt institution of therapy. Herein, we report a case of nocardial sepsis with native aortic valve endocarditis in a patient with breast cancer in whom multidisciplinary team involvement and prompt initiation of therapy have led to successful outcome.

Topics: Amikacin; Anti-Bacterial Agents; Anticoagulants; Aortic Valve; Breast Neoplasms; Central Venous Catheters; Clopidogrel; Cough; Endocarditis, Bacterial; Fatigue; Female; Headache; Heart Valve Prosthesis Implantation; Humans; Meropenem; Middle Aged; Nocardia; Nocardia Infections; Platelet Aggregation Inhibitors; Radiography, Thoracic; Sepsis; Treatment Outcome; Warfarin

Infective endocarditis (IE) is a life-threatening disease, mostly caused by gram-positive bacteria. Gram-negative bacteria were identified as a causative organism in relatively small number of cases. Although, antibiotic-resistant Escherichia coli is common cause of gram-negative endocarditis, AmpC beta-lactamase (BL)-harboring E coli is very rare cause of IE. Furthermore, emphysematous endocarditis is also a very rare manifestation of E coli infection.. We report a case of 80-year-old female patient presenting with dizziness, fever, and altered mental status, who was finally diagnosed with emphysematous endocarditis caused by E coli harboring an AmpC BL gene.. Her chest computed tomography revealed air bubbles surrounding the annulus of a mitral valve and a transesophageal echocardiogram revealed a hyperechogenic mass fixed on the posteromedial side of the mitral annulus with 2 eccentric mitral regurgitation jets. Blood cultures grew E coli which harbored the DHA-type AmpC BL. The organism belonged to a B2 phylogenic group, and multilocus sequence typing analyses revealed that the strains were of ST-95.. She was treated with meropenem following the resistant profiles, and surgery was recommended by the healthcare professional, but denied by the patient's guardians. She was transferred to another hospital due to a refusal for further treatment.. Emphysematous endocarditis is an uncommon complication of E coli bacteremia. Certain phylogenetic groups may be associated with development of E coli endocarditis.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Typing Techniques; beta-Lactamases; Echocardiography, Transesophageal; Emphysema; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Proteins; Female; Humans; Meropenem; Microbial Sensitivity Tests; Patient Care Management; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome

An 87-year-old woman presented to the emergency department with a 2-week history of progressively worsening shortness of breath, fever and generalised myalgia. She underwent a transcatheter Portico aortic valve implantation for severe symptomatic aortic stenosis 3 months prior to this presentation. Examination revealed a temperature of 40°C and a systolic murmur in the aortic area. Inflammatory markers were elevated, and blood cultures were positive for methicillin-sensitive

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Valve; Daptomycin; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Meropenem; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus aureus; Thienamycins; Transcatheter Aortic Valve Replacement

Acute renal failure caused by interstitial nephritis as part of a drug hypersensitivity syndrome constitutes a rare, but potentially life-threatening adverse drug reaction. We describe a patient with a mild maculo-papular rash accompanied by eosinophilia after prolonged treatment with meropenem, vancomycin, and moxifloxacin. Subsequently, a rapidly progressing renal failure developed which dominated the clinical picture. Upon cessation of all suspected drugs and therapy with high-dose steroids for 6 weeks, the renal function slowly returned to normal.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Aortic Valve; Aza Compounds; Biopsy; Diagnosis, Differential; Drug Eruptions; Drug Therapy, Combination; Endocarditis, Bacterial; Eosinophilia; Fluoroquinolones; Glucocorticoids; Humans; Kidney; Legionnaires' Disease; Male; Meropenem; Moxifloxacin; Nephritis, Interstitial; Quinolines; Sepsis; Skin; Thienamycins; Vancomycin

Lactobacilli are Gram-positive rod-shaped bacteria that inhabit the oral cavity, gastrointestinal tract, vagina and nasal cavity. In this report, a rare case of Lactobacillus jensenii endocarditis in a 47-year-old immunocompetent patient is described. Blood cultures and a replaced mitral valve were positive for L. jensenii as assessed by 16S rRNA gene sequencing. Based on susceptibility tests the patient was successfully treated with a mixture of teicoplanin and meropenem antimicrobial therapy.

Topics: Anti-Bacterial Agents; Blood; DNA, Bacterial; DNA, Ribosomal; Endocarditis, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Lactobacillus; Meropenem; Microbial Sensitivity Tests; Middle Aged; Mitral Valve; Molecular Sequence Data; Sequence Analysis, DNA; Teicoplanin; Thienamycins

A 79-year-old woman presented with fever, lethargy and weight loss. Clinically, the patient was confused, frail and had a systolic murmur. Her temperature was 38 °C and she remained persistently febrile. Initial investigations revealed neutrophilia with an elevated C reactive protein level. Multiple peripheral blood cultures grew Achromobacter xylosoxidans, a Gram-negative rod, which is a very rare cause of infection in patients who are immunocompetent. Subsequent transoesophageal echocardiography confirmed endocarditis with obvious vegetations on the mitral valve. The patient was treated with intravenous meropenem and cotrimoxazole in line with microbiology guidance. Surgical intervention in the form of mitral valve replacement was considered, but the patient was felt to be at prohibitive risk. After 6 weeks of intravenous antibiotics, a repeat transoesophageal echocardiogram showed no improvement in the mitral valve vegetation, which had increased in size. At this stage, her clinical course was complicated by major upper gastrointestinal bleeding requiring transfusion, multiorgan failure and ultimately death.

Topics: Achromobacter denitrificans; Aged; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Fatal Outcome; Female; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Meropenem; Mitral Valve; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Chromobacterium violaceum infection is uncommon but potentially fatal, with a clinical picture similar to melioidosis but with different antibiotic sensitivities and treatment. This infection can involve any organ, but we believe this is the first reported case of C. violaceum endocarditis.

Topics: Adult; Aortic Valve; Chromobacterium; Ciprofloxacin; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Liver Abscess, Pyogenic; Meropenem; Thienamycins; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Chromobacterium; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Humans; Liver Abscess, Pyogenic; Meropenem; Thienamycins

The case report of a young male with Endocarditis caused by Moraxella lacunata is presented. Although a well recognized cause of keratitis, conjunctivitis, and sinusitis; very few cases of endocarditis by this rare pathogen are reported in literature. Patient showed a prompt response when empirical therapy was de-escalated to penicillin, after receiving culture and sensitivity report from Microbiology department.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Endocarditis, Bacterial; Gentamicins; Humans; Male; Meropenem; Metronidazole; Moraxellaceae Infections; Penicillins; Protein Synthesis Inhibitors; Thienamycins; Vancomycin

Three episodes of bacteremia occurred in the course of prosthetic valve endocarditis caused by an extended-spectrum-beta-lactamase (ESBL)-producing Klebsiella pneumoniae strain. The second isolate developed resistance to ciprofloxacin and the third isolate to piperacillin-tazobactam (PIP-TZ) following sequential therapy with each agent. The first isolate was resistant to PIP-TZ only at high inocula, the second isolate acquired increased transcription of the acrA gene, and the third isolate became resistant to PIP-TZ due to loss of beta-lactamase inhibition by TZ. We question if and how PIP-TZ susceptibility should be reported for ESBL-producing Enterobacteriaceae.

Topics: beta-Lactamases; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Klebsiella Infections; Klebsiella pneumoniae; Meropenem; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prosthesis-Related Infections; Thienamycins

Topics: Anti-Bacterial Agents; Endocarditis, Bacterial; Humans; Imipenem; Meropenem; Thienamycins