A Rare Case of AICD Endocarditis caused by Staphylococcus Saprophyticus Treated Successfully with Antibiotics
V Laskova, K Cervellione, R Mendelson, H Vo, V Shamalov, F Bahgeri
coagulase-negative, endocarditis, staphylococcus saprophyticus
V Laskova, K Cervellione, R Mendelson, H Vo, V Shamalov, F Bahgeri. A Rare Case of AICD Endocarditis caused by Staphylococcus Saprophyticus Treated Successfully with Antibiotics. The Internet Journal of Infectious Diseases. 2007 Volume 6 Number 2.
To date, there have been two cases of endocarditis caused by
A 58-year-old female presented to the emergency room with fatigue, fever, chills, shortness of breath upon exertion, intermittent chest pain and dry cough for the previous four days. She denied any nausea, vomiting, abdominal pain, urinary symptoms or diarrhea. She was receiving hemodialysis for end stage renal failure via a right internal jugular tunneled catheter. A blood culture taken by the primary care physician two days prior to admission was positive for CoNS. The patient's medical history was positive for hypertension, diabetes mellitus, coronary artery disease with PCI and hypercholesterolemia. She had stent placement in the left anterior descending artery after myocardial infarction five years prior to the current admission and implantable cardiac defibrillator (AICD) placement 3-4 weeks prior to the current admission. The catheter site showed no signs of infection.
The patient reported drug allergies to penicillin, tetracycline, vancomycin and tobramycin; therefore, she was started on quinupristin/dalfopristin and ciprofloxacin to treat possible tunneled catheter infection. Removal of the catheter was considered, but it was decided to wait to determine whether there was improvement in symptoms after beginning treatment. TEE revealed a 5x3 mm, highly echogenic density on the tip of the anterior leaflet of the mitral valve with a small amount of independent motion, suggestive of a vegetation versus a calcification of the leaflet (Figure 1). The right atrium (RA) showed a pedunculated, medium-sized, echogenic density with a tiny, more mobile surface excrescence at the junction of the inferior vena cava and the RA cavity consistent with a vegetation. There was also a 12x10 mm, fixed density with a mobile excrescence at the junction of the RA and the superior vena cava involving the catheter representing a vegetation or thrombus (Figure 2). There was moderate regurgitation of the mitral and tricuspid valves. Four blood cultures (from arm) taken on the first three days of admission grew
The patient was transferred to another facility on day 10 of admission to be evaluated for possible revision of the AICD. The patient continued treatment at the receiving hospital. During her 17 day stay at the second facility she had no recurrence of the presenting symptoms except for a low-grade fever on days 15 and 16. Daily repeat blood cultures were consistently negative. Repeat TEE showed improvement of the infective endocarditis since the initial TEE approximately three weeks prior. All labs were within normal limits. It was decided not to remove the AICD due to improvement of the infection and the lack of further symptom development. The patient was eventually discharged to a nursing home facility to complete 6 weeks of antibiotic treatment.
The patient has been followed for 10 months since admission. She has had two subsequent hospitalizations, one for atrial fibrillation and one for coagulopathy due to drug interaction. There have been no signs or symptoms of endocarditis reoccurrence.
While CoNS are a common cause of prosthetic valve endocarditis (9), there has never been a report of endocarditis of a prosthesis due to
This report demonstrates the possibility of endocarditis of a prosthesis due to