Native valve endocarditis due to Escherichia coli infection: a case report and review of the literature

Abstract

BackgroundInfective endocarditis due to Escherichia coli is a rare disease but is increasing in frequency, especially among older women. In addition, its mortality rate is higher than that of endocarditis due to the HACEK-group gram-negative bacteria (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, and Kingela spp.).Case presentationA 58-year-old Japanese woman with a history of alcohol abuse was admitted to our hospital because of a fever. She was diagnosed with infective endocarditis due to E. coli based on repeated blood cultures and transthoracic echocardiography, which revealed vegetations attached to the anterior leaflet and chordae tendineae of the mitral valve. Despite administration of sulbactam/ampicillin and gentamycin, she developed purulent spondylitis during hospitalization and required treatment with meropenem administration for 6 weeks, leading to resolution of the endocarditis. She took oral levofloxacin for 2 months, and the spondylitis was completely cured 7 months after discharge.ConclusionEscherichia coli affects native valves without degenerative valvulopathy rather than prosthetic valves, especially in patients with risk factors such as an immunosuppressive status, excessive alcohol consumption, or treatment with hemodialysis. Peripheral embolization, congestive heart failure, and valve-ring abscesses are major complications of E. coli endocarditis; notably, infective myocarditis can also occur. The mortality and surgical intervention rates are 21% and 42%, respectively. Physicians should be cognizant of the necessity of surgical intervention when E. coli endocarditis is resistant to antibiotic therapy.

Antimicrobial Resistance in Escherichia coli Strains Isolated from Humans and Pet Animals

“…On the other hand, E. coli is often the main culprit of infections in the gastrointestinal tract [ 8 ], as well as other parts of human and animal organisms [ 9 , 10 ]. In more precise terms, E. coli typically causes urinary infections [ 11 , 12 ], but it can also lead to many other serious infections and conditions, such as: appendicitis [ 13 ], pneumonia [ 14 ], meningitis [ 15 ], endocarditis [ 16 ], gastrointestinal infections [ 17 ], etc. Research findings have shown us that E. coli can cause infections in all age groups and those infections can be acquired in the general population, i.e., community-acquired, as well as related to healthcare institutions [ 18 , 19 , 20 ].…”

Successful Resolution of Early-Onset Prosthetic Valve Endocarditis Associated With Extended Spectrum β-Lactamases Producing Escherichia coli With Medical Management

“…5 With the exception of the HACEK organisms (ie, Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella), Mitral valve is the most common site of infection (Table 1). 6,7 Mortality rates of 53% to 65% have been reported in patients with E coli endocarditis. 6,7 Although E coli does not stick to native heart valves as easily as staphylococci and streptococci, 8 it does cause PVE and has been reported with a frequency as high as 19%, in 7 of 37 cases of all cause endocarditis.…”

“…6,7 Mortality rates of 53% to 65% have been reported in patients with E coli endocarditis. 6,7 Although E coli does not stick to native heart valves as easily as staphylococci and streptococci, 8 it does cause PVE and has been reported with a frequency as high as 19%, in 7 of 37 cases of all cause endocarditis. 6 Some of the risk factors associated with infections caused by ESBL producing organisms are advanced age, female gender, diabetes mellitus, prolonged hospital stay, prior exposure to cephalosporins, quinolones, and 3 or more courses of antibiotic therapy in the preceding year.…”

Acute coronary syndrome caused by extrinsic coronary compression from an aortic root abscess in a patient with mechanical aortic valve endocarditis: a case report and literature review

“… 14 It does occur more commonly in prosthetic valves and previous systematic review reveals 52% has a urinary source as with our patient and up to a third are considered nosocomial in nature. 14 , 15 The mortality is high (21%). 15 Registry studies suggest the occurrence of intracardiac abscess with non-HACEK infection to be 42%.…”