A relapsed Pseudomonas stutzeri prosthetic valve endocarditis: a case report and review of the literature

Alabdely, Mayyadah; Alazmah, Mohammed; Alamro, Bandar; Alabdaljabar, Mohamad S.; Halim, Magid A.

doi:10.1186/s13256-021-03084-x

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…We found long-term contamination of surfaces, both from common pathogens like P. aeruginosa and less common, but increasingly appreciated pathogens like P. stutzeri ( 50 , 51 ). Hospital sinks acting as a reservoir of P. aeruginosa has been reported before ( 13 , 16 , 46 , 52 , 53 ), but here we show that persistence of these strains is common outside of an outbreak setting, and provide strong genomic evidence showing reappearance of a recently transferred isolate rather than a derivative lineage ( 18 ).…”

Section: Discussionmentioning

confidence: 94%

Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids

et al. 2023

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Contamination of hospital sinks with microbial pathogens presents a serious potential threat to patients, but our understanding of sink colonization dynamics is largely based on infection outbreaks. Here, we investigate the colonization patterns of multidrug-resistant organisms (MDROs) in intensive care unit sinks and water from two hospitals in the USA and Pakistan collected over 27 months of prospective sampling. Using culture-based methods, we recovered 822 bacterial isolates representing 104 unique species and genomospecies. Genomic analyses revealed long-term colonization by Pseudomonas spp. and Serratia marcescens strains across multiple rooms. Nanopore sequencing uncovered examples of long-term persistence of resistance-conferring plasmids in unrelated hosts. These data indicate that antibiotic resistance (AR) in Pseudomonas spp. is maintained both by strain colonization and horizontal gene transfer (HGT), while HGT maintains AR within Acinetobacter spp. and Enterobacterales, independent of colonization. These results emphasize the importance of proactive, genomic-focused surveillance of built environments to mitigate MDRO spread. IMPORTANCE Hospital sinks are frequently linked to outbreaks of antibiotic-resistant bacteria. Here, we used whole-genome sequencing to track the long-term colonization patterns in intensive care unit (ICU) sinks and water from two hospitals in the USA and Pakistan collected over 27 months of prospective sampling. We analyzed 822 bacterial genomes, representing over 100 different species. We identified long-term contamination by opportunistic pathogens, as well as transient appearance of other common pathogens. We found that bacteria recovered from the ICU had more antibiotic resistance genes (ARGs) in their genomes compared to matched community spaces. We also found that many of these ARGs are harbored on mobilizable plasmids, which were found shared in the genomes of unrelated bacteria. Overall, this study provides an in-depth view of contamination patterns for common nosocomial pathogens and identifies specific targets for surveillance.

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Section: Discussionmentioning

confidence: 94%

Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids

et al. 2023

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“…2,3 Prosthetic valve endocarditis (PVE) accounts for about 10% of all IE cases with Pseudomonas IE becoming increasingly common. 2 Halabi et al 4 and Alabdelly et al 5 both reported a rare fulminant case of P. stutzeri PVE resulting in early mortality. Casalta et al 6 reported a case of PVE caused by P. luteola after cardiac surgery leading to replacement of the aortic bioprosthetic valve.…”

Section: Discussionmentioning

confidence: 99%

“…While Pseudomonas species are rarely implicated as a cause, P. aeruginosa is the most common isolated pathogen. 2,4–11…”

Section: Discussionmentioning

confidence: 99%

‘TAVR Infected Pseudomonas Endocarditis’: a case report

Essien

Patterson

Estrada

et al. 2022

Therapeutic Advances in Infection

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Pseudomonas aeruginosa ( P. aeruginosa) rarely causes infective endocarditis (IE), previously reported for approximately 3% of all patients with IE.1 Most commonly, the infection occurs in intravenous drug users (IVDU) as right-sided endocarditis, noting presentations of P. aeruginosa IE without history of intravenous drug to be extremely rare, finding only a few cases reported in the literature. However there are increasing reports of cardiovascular implantable electronic device–related and prosthetic heart valve infections caused by this pathogen in non-IVDUs.2 This report will focus on the clinical presentation, management, and outcome of P. aeruginosa endocarditis in an 89-year-old patient with a transcatheter aortic valve replacement (TAVR). Medical management was pursued due to the patient’s underlying comorbidities. Long-term suppressive antibiotic therapy with delafloxacin was successful in maintaining negative blood cultures, despite an allergy to levofloxacin and ciprofloxacin. Plain Language Summary An 89-year-old male was admitted to our hospital after he was diagnosed with a blood stream infection. The initial identification noted gram-negative organisms consistent with Pseudomonas Aeruginosa so the patient was started on intravenous (IV) antibiotics. He improved after the antibiotics started and was discharged to a nursing facility to complete his antibiotics course. While at the facility, after he had finished his antibiotics, he started to become ill again. He was brought back to the hospital to be evaluated. His repeat blood cultures again grew P. Aeruginosa. This suggested that his infection had not been cleared the first time and most likely he had a source of bacterial growth. A few years prior, a transcatheter aortic valve replacement (TAVR) had been performed for the patient. This was suspected as the source of continued infection and so a transthoracic echocardiogram was obtained, which revealed vegetation on the TAVR. We also obtained a magnetic resonance imaging (MRI) of the brain, which demonstrated infarcts of several portions of the brain consistent with emboli. Due to his age and additional medical issues, the patient was not a candidate for surgical valve replacement. We decided to try medical therapy with a fluoroquinolone antibiotic since the bacteria was susceptible to it. Unfortunately, he had demonstrated allergies to the usual choices to include Levaquin and ciprofloxacin. Therefore, we elected to start him on a new fluoroquinolone agent that had recently been FDA approved and obtained by our facility called delafloxacin. The patient tolerated this well and his repeat blood cultures remain clear. After discussion with the infectious disease specialist, he requires a lifelong suppression with the medication since the TAVR cannot be removed. This case is meant to illustrate the effectiveness of medical therapy when surgical options are not available.

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“…S. stutzeri has been reported as a causative agent of some infections (pneumonia, meningitis, ocular infection, bacteraemia, osteomyelitis, joint infections, endocarditis), mainly in immunocompromised patients (Alwazzeh et al., 2020 ; Alabdely et al., 2021 ).…”

Section: Assessmentmentioning

confidence: 99%

Update of the list of qualified presumption of safety (QPS) recommended microbiological agents intentionally added to food or feed as notified to EFSA 18: Suitability of taxonomic units notified to EFSA until March 2023

Koutsoumanis¹,

Allende²,

Álvarez‐Ordóñez³

et al. 2023

EFS2

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The qualified presumption of safety (QPS) approach was developed to provide a regularly updated generic pre‐evaluation of the safety of microorganisms, intended for use in the food or feed chains, to support the work of EFSA's Scientific Panels. The QPS approach is based on an assessment of published data for each agent, with respect to its taxonomic identity, the body of relevant knowledge and safety concerns. Safety concerns identified for a taxonomic unit (TU) are, where possible, confirmed at the species/strain or product level and reflected by ‘qualifications’. In the period covered by this Statement, no new information was found that would change the status of previously recommended QPS TUs. Of 38 microorganisms notified to EFSA between October 2022 and March 2023 (inclusive) (28 as feed additives, 5 as food enzymes, food additives and flavourings, 5 as novel foods), 34 were not evaluated because: 8 were filamentous fungi, 4 were Enterococcus faecium and 2 were Escherichia coli (taxonomic units that are excluded from the QPS evaluation) and 20 were taxonomic units (TUs) that already have a QPS status. Three of the other four TUs notified within this period were evaluated for the first time for a possible QPS status: Anaerobutyricum soehngenii, Stutzerimonas stutzeri (former Pseudomonas stutzeri) and Nannochloropsis oculata. Microorganism strain DSM 11798 has also been notified in 2015 and as its taxonomic unit is notified as a strain not a species, it is not suitable for the QPS approach. A. soehngenii and N. oculata are not recommended for the QPS status due to a limited body of knowledge of its use in the food and feed chains. S. stutzeri is not recommended for inclusion in the QPS list based on safety concerns and limited information about the exposure of animals and humans through the food and feed chains.

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A relapsed Pseudomonas stutzeri prosthetic valve endocarditis: a case report and review of the literature

Cited by 4 publications

References 14 publications

Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids

Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids

‘TAVR Infected Pseudomonas Endocarditis’: a case report

Update of the list of qualified presumption of safety (QPS) recommended microbiological agents intentionally added to food or feed as notified to EFSA 18: Suitability of taxonomic units notified to EFSA until March 2023

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