Two Episodes of Stenotrophomonas maltophilia Endocarditis of Prosthetic Mitral Valve: Report of a Case and Review of the Literature

Abstract

Stenotrophomonas maltophilia (previously named Xanthomonas maltophilia) is an aerobic, non-fermentive, Gram-negative bacillus that is wide spread in the environment. It was considered to be an organism with limited pathogenic potential, which was rarely capable of causing diseases in human other than those who were in debilitated or immunocompromised state. More recent studies have established that Stenotrophomonas maltophilia can behave as a true pathogen. Endocarditis due to this organism is rare, and only 24 cases of Stenotrophomonas maltophilia endocarditis have been reported in the medical literature. Most cases were associated with risk factors, including intravenous drug abuse, dental treatment, infected intravenous devices, and previous cardiac surgery. We present a case with two episodes of Stenotrophomonas maltophilia endocarditis after mitral valve prosthesis implantation, which was treated with antibiotics initially, and a combination of antibiotics and surgery later. To our knowledge, this is the first case of repetitive endocarditis due to Stenotrophomonas maltophilia.

Cluster of Stenotrophomonas maltophilia endocarditis after prosthetic valve replacement

“…A similar case was reported by Kim et al, where prosthetic valve endocarditis occurred five years postsurgery with a relapse of the same infec tion two years later [13]. The long latency could have been due to a low bacterial load.…”

Stenotrophomonas maltophilia as an Emerging Ubiquitous Pathogen: Looking Beyond Contemporary Antibiotic Therapy

“…S. maltophilia , which is usually free living in the environment has been implicated in nosocomial infections and community based infections (Köseoglu et al, 2004 ; Meyer et al, 2006 ; Falagas et al, 2009 ). It has been reported as etiological agents in bacteraemia, ocular infection, endocarditis and RTIs (associated with cystic fibrosis), wound infection and urinary tract infections (UTI) (Kim et al, 2002 ; Platsouka et al, 2002 ; Arora et al, 2005 ). It is also an aetiologic agents of meningitis, sepsis, skin, and soft tissue infections (SSTI) and it has been diagnosed with rare cases of pyomyositis (Gales et al, 2001 ; Platsouka et al, 2002 ; Sakhnini et al, 2002 ; Arora et al, 2005 ; Pathmanathan and Waterer, 2005 ; Al-Anazi et al, 2006 ; Yemisen et al, 2008 ; Thomas et al, 2010 ).…”

“…Conditions like prolonged hospitalization, most common in ICU, implanted devices and mechanical ventilation, intravenous drug abuse, exposure to wide-range of antibiotics, as well as malignancy can predispose patients to infection (Rolston et al, 2005 ) which may progress immediately. Kim et al ( 2002 ) reported the establishment of S. maltophilia infection leading to endocarditis in a patient that had a replacement of valve with 27 mm Carbo Medics metallic due to severe rheumatic valvular disease. The duration of hospitalization of some patients before the onset of the Stenotrophomonas related clinical features and/or diagnosis is an important factor in nosocomial infection.…”

Management of Gram-negative and fungal endocarditis

“…High-dose trimethoprim-sulfamethoxazole (5 mg/kg trimethoprim every 6 h) should be instituted as soon as the genus diagnosis is made, possibly with a second agent as guided by susceptibility tests. Surgery is recommended, even in the absence of overt heart failure, and is mandatory in prosthetic IE cases in order to facilitate the eradication of this difficult-to-treat pathogen [27][28][29][30].…”