Bioprosthetic Aortic Valve Endocarditis in Association with Enterococcus durans

Abstract

Enterococci are common organisms associated with endocarditis, but infection by Case ReportIn September 2014, a 74-year-old man was admitted to our institution with a 2-month history of intermittent fever, malaise, weight loss, and anorexia. He had a long history of hypertension controlled successfully with angiotensin-converting enzyme inhibitors and diuretic agents. Nine months earlier, the patient had undergone aortic valve replacement with a Trifecta aortic pericardial valve (St. Jude Medical, Inc.; St. Paul, Minn) for the treatment of severe aortic valve stenosis. About one month before his current admission, the frequency of his fever increased and amoxicillin (2 g/d) was administered without benefit. The physical examination upon current admission revealed an axillary temperature of 37.1 °C, a blood pressure of 130/80 mmHg, and an oxygen saturation of 98% on ambient air. The patient had no Janeway lesions or Osler nodes. Cardiac auscultation revealed a diastolic murmur at the right sternal border. Laboratory test results were as follows: 6.9 leukocytes/mL (neutrophils, 70%); hemoglobin, 8.5 g/dL; platelets, 101/mL; C-reactive protein, 12,458 mg/dL; and an erythrocyte sedimentation rate of 115 mm/hr. Renal function and hepatic enzyme levels were normal. Urine culture results were negative.Chest radiographs and ultrasonograms of the abdomen showed no abnormal findings. A transthoracic color-flow Doppler echocardiogram (TTE), performed through a poor acoustic window, revealed left ventricular hypertrophy and a large vegetation on the prosthetic aortic valve, with mild-to-moderate regurgitation (Fig. 1). A transesophageal echocardiogram (TEE) confirmed that the prosthetic aortic valve was 9 mm in diameter at the noncoronary cusp (Fig. 2). On the basis of the presence of fever and a vegetation on the aortic bioprosthetic valve, together with the characteristics of the laboratory results, our primary diagnosis was infective endocarditis.On the day of our patient's admission, we drew blood for 3 sets of cultures and began empirical intravenous treatment with the antibiotic ceftriaxone (2 g/d). After 72 hours, all 3 blood cultures yielded E. durans, which antibiotic susceptibility testing showed was susceptible to teicoplanin (minimal inhibitory concentration [MIC]= 1 mg/dL), vancomycin (MIC=1 mg/dL), linezolid (MIC <2 mg/dL), and gentamicin (MIC <500 mg/dL). On the basis of these results, and in accordance with European Society of Cardiology guidelines on the prevention, diagnosis, and treatment of infective endocarditis, 1 we suspended treatment with ceftriaxone and substituted a combi-

Enterococcus durans Cardiac Implantable Electronic Device Lead Infection and Review of Enterococcus durans Endocarditis Cases

“…A PubMed database search as of 8 January 2021 yielded 312 original articles that mention "Enterococcus durans" or "E. durans"; out of these, 12 articles mention "endocarditis", and only 8 are case reports of IE caused by E. durans (see Figure 5 and Table 1) [2,[12][13][14][15][16][17][18].…”

“…A PubMed database search as of 08/01/2021 yielded 312 original articles that mention "Enterococcus durans" or "E. durans"; out of these, 12 articles mention "endocarditis", and only 8 are case reports of IE caused by E. durans (see Figure 5 and Table 1) [2,[12][13][14][15][16][17][18]. E. durians and the whole Enterococcus genus are important pathogenic agents due to the increasing number of multidrug-resistant (MDR) strains.…”

Enterococcus raffinosus, Enterococcus durans and Enterococcus avium Isolated from a Tertiary Care Hospital in Romania—Retrospective Study and Brief Review

“…In our review, we included thirteen case reports with E. durans as the etiologic agent. More than half, eight out of thirteen cases selected, were represented by infective endocarditis [53][54][55][56][57][58][59]. E. durans seems to be able to impair both the mitral and tricuspid valve as well as the aortic valve.…”