Serratia marcescens Endocarditis: A Case Report and Literature Review

Abstract

Serratia marcescens is a rarely implicated agent in endocarditis. We describe a case of a patient that underwent aortic and mitral valve replacement for Streptococcus agalactiae endocarditis. Four months later, he was readmitted with an ischemic stroke and fever. Physical examination and repetitive transthoracic echocardiogram were unremarkable. The initial blood cultures were negative. Due to sustained fever, vancomycin, gentamicin and piperacillin-tazobactam were initiated. On subsequent blood cultures, Serratia marcescens was isolated and antibiotics switched to ertapenem and gentamicin. In addition to cerebral emboli, a splenic embolus was found. The PET/CT revealed an abnormal hypercaptation in the mitral bioprosthesis. The patient was treated for six weeks. There are no current specific recommendations regarding the treatment of Serratia marcescens endocarditis. It is widely accepted that treatment should be prolonged and include a combination of antimicrobial agents. Morbidity and mortality are high, particularly when there’s the need for surgical replacement. In this case, however, the patient ended-up only requiring medical treatment due to the favourable response.

Brucella infection presenting as infective endocarditis complicated by embolic stroke

“…Cardiac involvement in brucellosis is rare but may be fatal. Infective endocarditis, the most common cardiac complication, is only found in 0.3–2% of the cases [7] , [8] , [9] . Nevertheless, it accounts for approximately 80% of the mortality in brucellosis [2] .…”

Endocardite da Válvula Mitral – Uma Causa Rara num Doente com Neoplasia

“…A endocardite por S.marcescens frequentemente afeta as valvas do lado esquerdo, causando destruição significativa da valva, embolização séptica e altas taxas de mortalidade sem intervenção cirúrgica. 6 , 7 , 9 , 10 A terapia antimicrobiana apropriada é incerta devido à considerável resistência aos antibióticos, mas os regimes aceitos geralmente envolvem uma combinação de um betalactâmico e um aminoglicosídeo. 4 , 5 , 8 A cirurgia é frequentemente negada a pacientes com câncer, mal orientados pelo conceito de carga considerável de comorbidades e a terapia antitumoral geralmente é suspensa.…”

“…Dada a sua raridade, cada caso relatado na literatura contribui para uma melhor compreensão das estratégias ideais de prevenção e tratamento. 9 , 10 - 12 …”

“…S. marcescens endocarditis often affects left-sided valves, causing significant valve destruction, septic embolization, and high mortality rates without surgical intervention. 6 , 7 , 9 , 10 Appropriate antimicrobial therapy is uncertain due to considerable antibiotic resistance but accepted regimens typically involve a combination of a beta-lactam and an aminoglycoside. 4 , 5 , 8 Surgery is often denied to cancer patients misguided by the concept of considerable comorbidity burden, and antitumoral therapy is usually withdrawn.…”

“…Given its rarity, each reported case in the literature contributes to better comprehending optimal prevention and treatment strategies. 9 , 10 - 12 …”