Serratia marcescens Tricuspid Valve Vegetation and Successful Use of the AngioVac® System

Winkle, Sean; Gaballa, Salem; Memon, Areeka; Miller, Jeremy B; Curfiss, Ryan

doi:10.7759/cureus.10010

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Serratia marcescens Endocarditis: A Case Report and Literature Review

Ferreira¹,

Silva²,

Reis³

et al. 2022

Acta Med Port

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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.

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Section: Discussionmentioning

confidence: 99%

Serratia marcescens Endocarditis: A Case Report and Literature Review

Ferreira¹,

Silva²,

Reis³

et al. 2022

Acta Med Port

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“…We also feel that not all percutaneous approaches are equal. Thus while a percutaneous approach to vegetation debulking using the AngioVac cannula has been reported, [6][7][8][9][10]23 there is a high incidence of blood transfusion, requirement for large bore cannulation with a bypass circuit, general anesthesia, and TEE.…”

Section: Discussionmentioning

confidence: 99%

“…However, this requires multiple large bore access with a 27 and 15 French sheath in the femoral and jugular vein. It is usually performed with an extracorporeal cardiopulmonary bypass circuit with transesophageal echocardiography guidance and general anesthesia 8‐11 …”

Section: Introductionmentioning

confidence: 99%

“…It is usually performed with an extracorporeal cardiopulmonary bypass circuit with transesophageal echocardiography guidance and general anesthesia. [8][9][10][11] The CAT8 Indigo Mechanical Aspiration System (Penumbra Inc., Alameda, California) is FDA-approved for the removal of soft, fresh thrombi in the arterial and venous system. Others have utilized this system for aspiration of vegetations during transvenous pacemaker lead extraction.…”

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confidence: 99%

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Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users

Akhtar¹,

Walker²,

Shakur

et al. 2021

Cathet Cardio Intervent

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Objectives A retrospective case series of a percutaneous approach to debulk tricuspid valve endocarditis (TVE) using an 8 French mechanical aspiration system in patients with a history of intravenous drug use (IVDU) was reported. IVDU associated TVE is increasing in the United States and is associated with high mortality despite early surgical debridement. Patients with advanced disease, shock, and respiratory failure may not be candidates for surgical debridement or replacement. These patients have recurrent events despite medical therapy Methods About 25 patients with IVDU associated TVE with persistent bacteremia confirmed by repeat blood cultures after 72 hr of sensitivity directed antibiotics and presence of pulmonary emboli confirmed by computed tomographic (CT) scan, who had undergone percutaneous aspiration were included. Patients were all deemed high risk for surgical debridement by a CT surgeon and evaluated by an infectious disease consultant. Procedures were performed under moderate sedation with intracardiac echo and a steerable guide with a CAT8 Penumbra aspiration catheter. Results There were no intraprocedural deaths or complications. About 36% had septic shock on presentation. Survival of index hospitalization was 88%. Repeat blood cultures showed no growth on all surviving patients. Readmission rate was 4% (n = 1) at 1 month. About 40% (n = 2) patients with septic shock survived at 1 month compared with 100% survival (n = 20) in those without shock. Presence of septic shock was associated with reduced survival at 1 month (p < .01). Conclusion Percutaneous mechanical aspiration with an 8 Fr system is a feasible, minimally invasive alternative to surgical debulking. Mortality remains high in those presenting with septic shock. Further studies are needed to evaluate long‐term outcomes.

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“…The literature is lacking, though, in describing the factors that may predict increased growth and persistence of vegetations. In addition, the impact of hepatitis B or C on the vegetation size has not been explored, although a few case reports and one analysis show the co-existence of hepatitis in patients with tricuspid valve endocarditis and IV drug use [10][11][12]. We performed a retrospective analysis of patients with native valve endocarditis to assess the natural history of cardiac vegetation with adequate antimicrobial therapy.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Review of the Natural Progression of Cardiac Vegetation

Bhatia¹,

Asghar²,

Khan³

et al. 2022

Cureus

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Introduction: Infective endocarditis (IE) is a life-threatening condition with an annual mortality of up to 40%. Vegetations are the hallmark of IE, however, factors that affect the initial size and changes in size remain unclear. Our study aims to investigate the natural history of cardiac vegetation, including changes in size and/or resolution with adequate treatment, and to analyze factors that influence size and potential for persistence.Material and methods: We conducted a retrospective review of 102 patients admitted with native-valve endocarditis at Henry Ford Health System from September 1, 2017, to June 30, 2019. We included patients treated with six weeks of intravenous antibiotics who had both a diagnostic and a follow-up echocardiogram after antibiotic completion.The primary outcome was the change in vegetation size. Secondary measures included pathogen identification, valve involvement, number of complications, associated IV drug use, and co-infection with hepatitis B/C. Results: Of the 102 patients reviewed, 30 patients matched the inclusion criteria. There was a significant decrease in vegetation size after adequate antibiotic treatment. However, complete resolution was not often seen. A statistically significant relationship was seen between vegetation size, IV drug use, and Staphylococcal species (including both methicillin-susceptible Staphylococcus aureus [MSSA] and methicillin-resistant S. aureus [MRSA]), whereas a history of hepatitis B or C was not significantly related to vegetation size. Conclusion: Large vegetation may predict a higher risk of embolic complications and can be reduced with IV antibiotics, although complete resolution is not likely. IV drug use and Staphylococcal endocarditis influence vegetation size and embolic complications. We argue that these subgroups should be prioritized for early surgical intervention.

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Serratia marcescens Tricuspid Valve Vegetation and Successful Use of the AngioVac® System

Cited by 9 publications

References 16 publications

Serratia marcescens Endocarditis: A Case Report and Literature Review

Serratia marcescens Endocarditis: A Case Report and Literature Review

Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users

A Retrospective Review of the Natural Progression of Cardiac Vegetation

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