Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment

A fatal case of Trichosporon inkin prosthetic endocarditis is reported. The isolation sites and susceptibility profiles of 10 other isolates are also reviewed. Four strains were recovered from cutaneous or subcutaneous samples, four were recovered from urine, one was recovered from peritoneal liquid, and one was recovered from bone. Voriconazole and amphotericin B had the most potent activities in vitro against the isolates, with MIC geometric means of 0.11 and 0.30 g/ml, respectively. CASE REPORTA 52-year-old male underwent biological valve replacement for an insufficient aortic valve in October 1987. In May 2001, he developed valvular dysfunction with heart failure, and a second aortic valve replacement was performed. Fifteen months later, the patient presented to the Emergency Department with skin lesions on both hands, swelling of the right wrist, and articular pain. Physical examination revealed a temperature of 37.8°C and a leukocyte count of 12.8 ϫ10 6 per liter. Blood culture samples were taken, and the patient was discharged with the diagnosis of cellulitis and placed on amoxicillin-clavulanate therapy. Two days later, he came to the Infectious Diseases outpatient clinic with new skin lesions. An examination showed Osler's nodes in the fingers of both hands and in the feet and splinter hemorrhages on the nail folds. Transthoracic echocardiography showed a huge vegetation along the rim of the prosthetic aortic valve. After two new sets of blood cultures were performed, antibiotic therapy with vancomycin (1 g/12 h), gentamicin (80 mg/8 h), and rifampin (600 mg/day) was instituted. Forty-two hours later, the patient developed left hemiparesis and was transferred to another hospital for cardiovascular surgery. Unfortunately, after another 30 hours, he suffered a cardiopulmonary arrest and died before the surgery could be performed. An autopsy was not done.No growth was detected in the broth blood cultures after 7 days of incubation, but subcultures on Sabouraud glucose agar with gentamicin and chloramphenicol yielded colonies of a cream-colored organism after 48 h of incubation. Microscopic examination revealed budding cells and arthroconidia. Urease activity was positive. The API ID32C clinical yeast identification system (Biomerieux SA, Marcy-L'Etoile, France) was used to identify the isolate. With this commercial kit, we obtained the code 525764371, which is listed in the API ID32C database as a very good identification of Trichosporon inkin. However, the strain did not show growth on N-acetylglucosamine (the carbon source), a test by which the majority of T. inkin strains included in the API database are positive. Therefore, the isolate was sent to the Mycology Laboratory of the National Center for Microbiology of Spain for definitive identification and susceptibility testing.Identification of the isolate. At the National Center for Microbiology, the strain was labeled as CNM-CL-4811 (Spanish Centro Nacional de Microbiología yeast culture collection). The isolate was identified by routine physiological ...

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“…Our patient was probably infected during the operation, as has been described for other prosthetic infections (1). Trichosporon spp.…”

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confidence: 74%

Clinical Case of Endocarditis due toTrichosporon inkinand Antifungal Susceptibility Profile of the Organism

Ramos¹,

Cuenca‐Estrella

Gutiérrez³

et al. 2004

J Clin Microbiol

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“…Podobnie jak w NVE kluczowe znaczenie odgrywa ocena prognostyczna, pozwalająca na identyfikację pacjentów wysokiego ryzyka, u których konieczne może być podjęcie bardziej intensywnej strategii postępowania. Kilka czynników, wśród których należy wymienić podeszły wiek, cukrzycę, zakażenie związane z kontaktem z opieką zdrowotną, zakażenie gronkowcowe lub grzybicze, wczesne PVE, HF, udar mózgu oraz ropnie wewnątrzsercowe, wiąże się ze złym rokowaniem w przypadku IZW u pacjentów ze sztuczną zastawką [161,216,[350][351][352][353]. Spośród tych czynników najsilniejszymi markerami złego rokowania są powikłane PVE oraz zakażenie gronkowcowe.…”

Section: Rokowanie I Leczenieunclassified

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

144

212

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“…The results of the current study showed that PVE was associated with high overall in-hospital mortality (35%). Despite improvements in diagnosis, medical treatment and surgery, PVE carries a high mortality risk ranging from 20-80% of affected patients [10][11][12][13][14][15]. In general, combined medical and surgical treatment is considered the management of choice in patients with PVE.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the data on clinical outcomes of PVE come from western countries [7,8] and there is a lack of data in Turkey regarding nation-wide multicenter experience. Therefore our aim was to investigate the etiology and risk factors for PVE and identify clinical, echocardiographic and prognostic features of the patients with PVE and determine the risk factors for adverse outcome during hospital admission in Turkey.…”

Section: Introductionmentioning

confidence: 99%

Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study

Elbey

Kalkan²,

Akdağ³

et al. 2013

Cardiol J

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(OR 24.5;) and high CRP (OR 1.02; 95% CI 1.00-1.03) measured on admission were independent risk associates for in-hospital mortality Conclusions: High creatinine level, poor functional status and high CRP measured on admission were independent risk associates for in-hospital mortality, whereas a NYHA class of III/IV and high CRP reflected independent risk for stroke/mortality end point. (Cardiol J 2013; 20, 3: 323-328)

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Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment

Cited by 101 publications

References 7 publications

Clinical Case of Endocarditis due toTrichosporon inkinand Antifungal Susceptibility Profile of the Organism

Clinical Case of Endocarditis due toTrichosporon inkinand Antifungal Susceptibility Profile of the Organism

2015 ESC Guidelines for the management of infective endocarditis

Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study

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