Aortic homograft endocarditis caused by Cardiobacterium hominis and complicated by agranulocytosis due to ceftriaxone

Abstract

The present report describes a very rare case of an aortic homograft valve endocarditis caused by Cardiobacterium hominis. The case was complicated by an agranulocytosis after 3 weeks of antibiotic treatment induced by ceftriaxone. Alternative oral treatment with ciprofloxacin and rifampicin was successful, no surgical intervention was needed and homograft function could be preserved.

Ciprofloxacin for the treatment of Cardiobacterium hominis prosthetic valve endocarditis

“…This is well below the Clinical and Laboratory Standards Institute (CLSI) breakpoint of ≤1 ug/mL [ 10 ]. It is also in the range of MIC values 0.012–0.5 ug/mL reported in the literature [ [4] , [5] , [7] ]. In the case report by Vogt et al, the authors performed a killing curve assay using the patient’s serum after receiving ciprofloxacin 200 mg combined with 5 × 10 5 cfu/mL of organisms.…”

“…Patients with endocarditis who are unable to tolerate first line therapy can be treated with a fluoroquinolone (ciprofloxacin, levofloxacin, or moxifloxacin) for 6 weeks based on limited evidence [ 2 ]. There are only six published case reports of Cardiobacterium hominis that utilize ciprofloxacin as part of combination therapy or as salvage therapy [ [4] , [5] , [6] , [7] , [8] , [9] ] ( Table 1 ). Clinical cure was achieved in 5 of the 6 patients [ [4] , [5] , [6] , [7] , [8] ] with surgical intervention in 3 patients [ [7] , [8] , [9] ].…”

“…There are only six published case reports of Cardiobacterium hominis that utilize ciprofloxacin as part of combination therapy or as salvage therapy [ [4] , [5] , [6] , [7] , [8] , [9] ] ( Table 1 ). Clinical cure was achieved in 5 of the 6 patients [ [4] , [5] , [6] , [7] , [8] ] with surgical intervention in 3 patients [ [7] , [8] , [9] ]. In 4 cases, ciprofloxacin was combined with either rifampin, ceftriaxone, ceftriaxone and gentamicin, or penicillin, gentamicin, and imipenem-cilastatin [ [5] , [6] , [8] , [9] ].…”

“…Clinical cure was achieved in 5 of the 6 patients [ [4] , [5] , [6] , [7] , [8] ] with surgical intervention in 3 patients [ [7] , [8] , [9] ]. In 4 cases, ciprofloxacin was combined with either rifampin, ceftriaxone, ceftriaxone and gentamicin, or penicillin, gentamicin, and imipenem-cilastatin [ [5] , [6] , [8] , [9] ]. Our case report is unique in that ciprofloxacin monotherapy was used for the entire course of therapy, including step-down to oral ciprofloxacin to complete 6 weeks of treatment avoiding the long term use of a peripherally inserted central line.…”

Ceftriaxone‐induced neutropenia successfully overcome by a switch to penicillin G in Cardiobacterium hominis endocarditis

“…Cardiobacterium hominis is a Gram‐negative rod‐shaped bacterium colonizing the mouth and the upper respiratory tract. It can cause endocarditis, predominantly prosthetic valve endocarditis 1,2 . It is a member of the HACEK group ( Haemophilus spp., Aggregatibacter actinomycetemcomitans , Cardiobacterium hominis , Eikenella corrodens , Kingella kingae ) consisting of Gram‐negative bacteria which are part of the normal flora of the oral cavity and upper respiratory tract in humans and can cause endocarditis typically in patients with heart diseases or artificial valves 3 .…”