meropenem and Endocarditis

Aggregatibacter aphrophilus（A. aphrophilus）is one of the organisms of the HACEK group. Previously reported cases of brain abscesses caused by A. aphrophilus infection have occurred in children with a basis for congenital heart disease, or in adults with a basis for dental disease. Rare cases of brain abscess caused by A. aphrophilus have been reported in adults with congenital heart disease or in patients without dental disease history. Herein we present a rare case of brain abscess caused by A. aphrophilus, who was in association with atrial septal defect for more than 20 years, and had no dental disease and did not develop infective endocarditis.. A 51-year-old female was admitted due to progressively worsening headache and left limb weakness for more than 10 days. She denied the history of chronic diseases such as hypertension and diabetes, and no periodontal disease. While she had a history of atrial septal defect, a form of congenital heart disease with severe pulmonary hypertension for more than 20 years. After admission, echocardiographic illustrated congenital heart disease with severe pulmonary hypertension. CT and MRI showed brain abscess. Cerebrospinal fluid (CSF) results also confirmed the presence of intracranial infection. Empirical therapy with vancomycin 1.0 g i.v q12h and meropenem 2.0 g i.v q8h was initiated from the day of admission. On the fourth day after admission, brain abscess resection and decompressive craniectomy were performed, and the pus drained on operation were cultured and Gram-negative bacilli grew, which was identified as A.aphrophilus. Vancomycin was discontinued and meropenem was continued（2.0 g i.v q8h）for 5 weeks, followed by oral levofloxacin 0.5 qd for 4 weeks of out-patient antibiotics. The patient recovered fully within 9 weeks of treatment.. This is the first case of A. aphrophilus to cause brain abscess in adult with a history of congenital heart disease for more than 20 years, who had no dental disease and did not develop infective endocarditis. We also highlight the value of bacterial 16 S rDNA PCR amplification and sequencing in identifying bacteria in abscesses which are culture-negative, and prompt surgical treatment，choosing effective antibiotics and appropriate course of treatment will get better clinical effect.

Topics: Adult; Aggregatibacter aphrophilus; Anti-Bacterial Agents; Brain Abscess; Child; Endocarditis; Female; Heart Defects, Congenital; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Meropenem; Middle Aged; Pasteurellaceae Infections; Vancomycin

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

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

We report the case of using a long-term combination of meropenem and amikacin to treat infective endocarditis caused by Enterobacter cloacae resistant to third- and fourth-generation cephalosporins. Multi-drug resistant Gram-negative bacilli, such as the E. cloacae in our study, may become possible pathogens of infective endocarditis. Our experience with this case indicates that long-term use of a combination of β-lactam and aminoglycosides might represent a suitable management option for future infective endocarditis cases due to non-Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella spp. (HACEK group) Gram-negative bacilli such as ours.

Topics: Aged; Amikacin; Anti-Bacterial Agents; beta-Lactam Resistance; Cephalosporins; Endocarditis; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Male; Meropenem; Thienamycins; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftazidime; Coronary Sinus; Diagnosis, Differential; Endocarditis; Female; Follow-Up Studies; Gentamicins; Humans; Hypertension; Kidney Failure, Chronic; Meropenem; Renal Dialysis; Thienamycins; Treatment Outcome; Ultrasonography; Young Adult