A Complicated Case ofSerratia marcescensInfective Endocarditis in the Era of the Current Opioid Epidemic

Abstract

While bacteremia due to Serratia marcescens is not uncommon, it rarely causes infective endocarditis. We report an isolated case of a 53-year-old male with history of intravenous drug abuse who presented with multiple acute pain symptoms and was found to have S. marcescens bacteremia with septic emboli in his spleen, brain, and testes, secondary to a large aortic vegetation, as well as aortic infective endocarditis with severe aortic regurgitation requiring aortic valve replacement. His course of disease was further complicated by epidural and psoas abscesses and a necrotic testicle requiring orchiectomy due to his ongoing intravenous drug abuse. This case is an atypical presentation of S. marcescens infection, as he had no overt signs of infection such as fever or significant leukocytosis that are typical of bacteremia, and it also highlights the severity and complicated nature of S. marcescens-infective endocarditis.

Serratia marcescens Endocarditis with Perivalvular Abscess Presenting as Atrioventricular Block

“…Paravalvular complications and valvular destruction are documented in previous cases of S. marcescens endocarditis. Surgical intervention is recommended within 7-10 days, especially for patients with left side involvement [1]. In fact, mortality is noted to be as high as 85% in patients with S. marcescens endocarditis who only received medical therapy.…”

“…Surgical consultation must be obtained if vegetations, paravalvular abscess, or involvement of valves are noted on echocardiogram. Failure to seek appropriate surgical treatment can result in persistent bacteremia, risk of embolization, and heart failure [1,5].…”

“…Serratia marcescens is an aerobic, motile, oxidase-negative, and Gram-negative bacillus first identified in 1819 [1]. S marcescens is an opportunistic pathogen associated with intravenous drug use, immunosuppression, previous antibiotic exposure, and indwelling catheterization.…”

A Case ofSerratia marcescensEndocarditis in a Nonintravenous Drug-Using Male Patient and Review of Literature

“…Septic embolization is also common. Antibiotic treatment alone is usually insufficient, and surgical replacement of the involved valve is needed [1–7].…”

Embolic serratia aortic valve endocarditis

“…S. marcescens IE has high mortality rate of 68 % [ 2 ].The disease tends to have a predilection to the left side of the heart involving the aortic and mitral valves equally [ 1 ]. Heart failure and peripheral emboli have been described [ 1 , 4 ].…”