Non-nosocomial healthcare-associated left-sided Pseudomonas aeruginosa endocarditis: a case report and literature review

BMC Infectious Diseases

Case Report

Kohei Takimoto¹  Takeshi Tanaka²  Norihisa Yamamoto³  Hideharu Hagiya³  Hisao Yoshida³  Kazunori Tomono³  Yukihiro Akeda³ 

[1] Department of Anesthesiology and Intensive Care Medicine, Osaka University Hospital, Osaka, Japan;Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan;Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, 565-0871, Osaka, Japan;

关键词: Healthcare-associated infective endocarditis;    Patent foramen ovale;    Right-to-left shunt;    Urethral self-catheterization;   

DOI  :  10.1186/s12879-016-1757-y

 received in 2015-10-20, accepted in 2016-08-04,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundWith 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.Case presentationA 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.ConclusionsWe 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.

【 授权许可】

CC BY   
© The Author(s). 2016