A Unique Case of Burkholderia cepacia Prosthetic Mitral Valve Endocarditis and Literature Review

Dellalana, Laura E.; Byrge, Kelly Carpenter; Gandelman, Jocelyn S.; Lines, Tara; Aronoff, David M.; Person, Anna K.

doi:10.1097/ipc.0000000000000708

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…Casalta et al 6 reported a case of PVE caused by P. luteola after cardiac surgery leading to replacement of the aortic bioprosthetic valve. Similar reports of other Pseudomonas species prosthetic valve infections, 7–11 as shown in Table 1, have been reported in the literature with a noted common theme of increased morbidity and mortality. While Pseudomonas species are rarely implicated as a cause, P. aeruginosa is the most common isolated pathogen.…”

Section: Discussionsupporting

confidence: 85%

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‘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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Section: Discussionsupporting

confidence: 85%

“…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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“…The present study found that patients infected with Burkholderia cepacia were predominantly detected in the Internal Medicine wards. B. cepacia is known to cause various diseases and is often found in patients with a history of conditions that affect the function of internal organs, such as cystic fibrosis ( 7 , 8 ), infectious endocarditis ( 20 ), and chronic granulomatous disease ( 10 ). In addition to the internal medicine wards, patients treated in ICU rooms also had a higher number of B. cepacia isolates during the study, similar to previous research showing a higher occurrence of B. cepacia in ICU rooms compared to non-ICU rooms ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Burkholderia cepacia recovered from clinical specimens in the Zainoel Abidin general hospital, Banda Aceh, Indonesia

Suhartono¹,

Mahdani²,

Muzayanna³

2023

IJM

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Background and Objectives: Burkholderia cepacia is one of the multiple intrinsic resistant bacteria causing opportunistic infections. The study aimed to determine the distribution of B. cepacia isolates based on types of clinical specimen, hospital wards, and the patient's gender-age and to evaluate their antibiotic susceptibility. Materials and Methods: This study involved isolating, identifying, and testing antibiotic susceptibility of B. cepacia iso- lates recovered from clinical specimens of Dr. Zainoel Abidin general hospital (RSUDZA) Banda Aceh Indonesia during March 2019-March 2022. Results: In total, there were 3,622 Gram-negative bacterial isolates of 10,192 clinical specimens obtained during the study period and B. cepacia was positively detected in 127 isolates (1.24%). Most of the 127 isolates of B. cepacia were found in blood and sterile body fluid samples (55.11%) followed by urine and pus samples accounting for 23.62% and 13.37%, respectively. The internal medicine wards had the highest number of detected B. cepacia isolates at 28.3%. B. cepacia infec- tions were more common in men (59.05%) and people over 45 years old (41.73%). The bacteria were highly sensitive to the antibiotic ceftazidime (92.7%). Conclusion: Culture examination of clinical specimens is not required for confirmed infections, despite being essential for appropriate antibiotic treatment. Implementing surveillance programs and judicious use of antibiotics can prevent bacterial transmission.

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“…Endocarditis caused by BCC was more commonly reported for patients with prosthetic valves ( 37 ) and for patients with a history of injection drug use and native valve involvement ( 38 ). Patient 3 exhibited the clinical features of right-sided endocarditis.…”

Section: Discussionmentioning

confidence: 99%

Invasive Burkholderia cepacia Complex Infections among Persons Who Inject Drugs, Hong Kong, China, 2016–2019

Luk¹,

Tsang²,

Ho³

et al. 2022

Emerg. Infect. Dis.

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During March 2016–January 2019, Burkholderia cepacia complex (BCC) infection developed in 13 persons who inject drugs (PWID) in Kowloon West Region, Hong Kong, China. Seven cases were infective spondylitis, 2 endocarditis, 2 septic arthritis, 1 intramuscular abscess and bacteremia, and 1 necrotizing fasciitis. Pulsed-field gel electrophoresis revealed that the isolates from 9 patients were clonally related. This clone caused major illness, and 11 of the 13 patients required surgical treatment. Clinicians should be aware of this pathogen and the appropriate broad-spectrum antimicrobial drugs to empirically prescribe for PWID with this life-threatening infection. Close collaboration among public health authorities, outreach social workers, and methadone clinics is essential for timely prevention and control of outbreaks in the PWID population.

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A Unique Case of Burkholderia cepacia Prosthetic Mitral Valve Endocarditis and Literature Review

Cited by 4 publications

References 18 publications

‘TAVR Infected Pseudomonas Endocarditis’: a case report

‘TAVR Infected Pseudomonas Endocarditis’: a case report

Prevalence of Burkholderia cepacia recovered from clinical specimens in the Zainoel Abidin general hospital, Banda Aceh, Indonesia

Invasive Burkholderia cepacia Complex Infections among Persons Who Inject Drugs, Hong Kong, China, 2016–2019

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