A case of Enterococcus jaecalis endocarditis followed endoscopic retrograde cholangiopancreatography and percutaneous extraction of a biliary calculus is reported. The most likely cause of endocarditis, though unproven, is the latter procedure, as the bile is often infected during biliary tract obstruction, and bacteremia is freq u ent du ring percutaneous manipulations. Initial therapy with vancomycin was unsuccessful in clearing the bacteremia, possibly due B ACTERIAL ENDOCARDITIS OF A NORMAL HEART VALVE has not been reported as a consequence ofT tube manipulation or endoscopic retrograde cholangiopancreatography (ERCP). The authors recently managed a case of Enterococcus jaecalis endocarditis that occurred following these procedures, and which faile d to resolve with initial therapy using vancomycin alone. to vancomycin tolerance of the isolate and lack of an aminoglycoside in the initial regimen. Cure was obtained when therapy with ampicillin and gentamicin was underta ken. Can J Infect Dis 1990;1(4):143-145
Department of Infectious Diseases and Medical
Key Words : B ilia r y , E n doca r d i tis . Enterococcus faecalis. Endoscopic retrograde cho langiopan creatography. Vancomycin
CASE PRESENTATIONA 58-year-old male was admitteu to hospital with a two week history of fever, chills and sweats. Six months previou s ly he had had a cholecystectomy for acute obstructive jaun dice, at which time calculi that could not be extracted were presen t in the common b ile duct. He u nderwent ERCP twice in the next two months with removal of one calculus on each occasion. On e week after the last ERCP and four months prior to admission, the T tube was cannulated and a fina l calculus extracted with difficulty. Prop hylaxis with cefoxitin was used at the initial s u rgery, and a bile culture at surgery was negative . The s u bsequent procedures were done without antibiotic prophylaxis , and no cultures were taken.143