Non-nosocomial healthcare-associated left-sided Pseudomonas aeruginosa endocarditis: a case report and literature review. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Hagiya, Hideharu; Tanaka, Takeshi; Takimoto, Kohei; Yoshida, Hisao; Yamamoto, Norihisa; Akeda, Yukihiro; Tomono, Kazunori
• Is Part Of: BMC infectious diseases. Volume 16:Issue 1(2016)
• Page Start: 1
• Page End: 7
• Publication Date: 2016-12
• Subjects: Healthcare-associated infective endocarditis -- Patent foramen ovale -- Right-to-left shunt -- Urethral self-catheterization; Communicable diseases -- Periodicals; Sexually Transmitted Diseases -- Periodicals; 616.905
• DOI: 10.1186/s12879-016-1757-y
• Languages: English
• ISSNs: 1471-2334

Abstract

Abstract Background 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. Case presentation 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 identifiedPseudomonas 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 ofP. 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-sidedP. 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. Conclusions We presented a rare case of native aortic valve endocarditis caused byP. aeruginosa . This case illustrates the importance of identifying the causative pathogen(s), especially for outpatients with a recent history of medical procedures.