Serratia marcescens Endocarditis with Perivalvular Abscess Presenting as Atrioventricular Block

Abstract

Serratia marcescens is an aerobic, Gram-negative bacillus first identified in 1819 (Yeung et al. 2018). S. marcescens infective endocarditis is extremely rare accounting for only 0.14% of all cases (Phadke and Jacob 2016, Hadano et al. 2012, Nikolakopoulos et al. 2019). We present the case of a 33-year-old male with a past medical history of Hodgkin lymphoma, nonischemic cardiomyopathy ejection fraction of 25–30%, severe aortic stenosis, hepatitis C, and active intravenous (IV) drug abuse who was admitted following a motor vehicle accident. Approximately 10 days into his admission, he developed a 39.5 degree Celsius fever, which prompted collection of blood cultures. These cultures were positive (2 out of 2) for S. marcescens for which he was treated with intravenous cefepime. Soon after this diagnosis, patient developed a complete AV block. Given the instability of the patient, he required emergent placement of a temporary pacing wire. Transesophageal echocardiogram was ordered and revealed an aortic root abscess. Given the comorbidities and active IV drug use, conservative management was pursued. Although rare, trends suggest that this pathogen may be on the rise. Further research is needed to better understand how to effectively manage this pathogen.

Serratia marcescens Endocarditis: A Case Report and Literature Review

“…1 This may be recommended within the first seven to 10 days after beginning antimicrobial therapy. 13 In contrast with the majority of cases described, surgery was deemed unnecessary in our patient as he remained asymptomatic with normal valve function after receiving antibiotic therapy. Despite the presence of a prosthetic valve, the causative agent, the patient's comorbidities and the occurrence of cerebral septic emboli, our case may be an example that, in some selected patients and according to clinical evolution, antibiotic treatment may be sufficient.…”

“…1 Only 15 cases were reported since 1994 (Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In nine cases, the risk factor for infection was IVDU; in the group of health-care-associated endocarditis only one had a prosthetic valve 8 and one pacemaker. 5 Similarly, most of the cases had either immunosuppressive or chronic disease.…”

“…1,10 Concurrent administration of aminoglycosides leads to a rapid sterilization of the affected valve. 1 In most patients, antimicrobial therapy is insufficient and surgical treatment is needed due to poor prognosis 13 and the pathogenicity of the microorganism. 1 This may be recommended within the first seven to 10 days after beginning antimicrobial therapy.…”

Serratia endocarditis, uncommon organism, with significant complications

“…Serratia marcescens was first identified in 1819, and S. marcescens related infective endocarditis was first reported in 1951. 1 S. marcescens is a facultative aerobic, motile, oxidase-negative, nonlactose-fermenting, Gram-negative bacillus of the family Enterobacteriaceae. It is not present in human commensal flora, and human infections are mostly acquired from hospital settings.…”

A Rare Presentation of Infective Endocarditis Due to Serratia marcescens

“…Non-HACEK infective endocarditis is rare with a 2% incidence and associated with poor outcomes [6]. S. marcescens endocarditis is extremely rare, accounting for only 0.14% of all cases of endocarditis [5,7]. Most published cases of it have been in patients who have chronic medical conditions or cardiovascular abnormalities [1].…”