Lost without Occam's razor: Escherichia coli tricuspid valve endocarditis in a non-intravenous drug user

Abstract

SummaryThe unusual case of a 31-year-old woman who developed tricuspid valve endocarditis with positive blood cultures for Escherichia coli is presented. The patient had no underlying cardiac disease or predisposing conditions that could have made her susceptible to the native valve infection. Despite a lengthy course of intravenous antibiotics only a partial response was achieved. The patient underwent cardiac surgery and had a good postoperative recovery. BACKGROUND

Native valve endocarditis due to Escherichia coli infection: a case report and review of the literature

“…Peripheral embolization, congestive heart failure, and valve-ring abscesses have been reported as complications of non-HACEK gram-negative endocarditis [ 33 ]. Among all reviewed patients in the present report, eight (24%) had peripheral embolization [ 10 , 11 , 14 , 16 , 18 , 19 , 30 , 32 ], and six (22%) had congestive heart failure [ 11 – 13 , 16 , 20 , 25 ]. Intracardiac or valve-ring abscesses were reported in eight (18%) patients [ 12 , 15 , 16 , 23 , 30 ].…”

“…Non-valvular IE was reported in two patients [ 26 , 29 ]. The tricuspid or pulmonary valves were also affected; vegetations on the tricuspid valve and pulmonary valve were reported in three and one patient, respectively [ 1 , 18 , 19 , 21 ].…”

“…Therefore, antibiotic stability against β-lactamases should be considered when choosing β-lactams for therapy of E. coli IE. Aminoglycosides and fluoroquinolones were administered with β-lactams or carbapenems in 21 and 7 patients, respectively [ 10 , 11 , 13 , 15 – 18 , 20 , 21 , 23 , 25 – 28 , 30 , 31 ]. Four patients were treated with both aminoglycosides and fluoroquinolones besides β-lactams or carbapenems, and three of these four patients required surgical treatment despite ESBL-negative E. coli infection [ 16 , 25 , 27 ].…”

“…Among patients with non-HACEK gram-negative endocarditis, the mortality rate did not significantly differ between patients receiving medical therapy alone and those undergoing surgical treatment, and the in-hospital mortality and cardiac surgery rates were reportedly 24% and 51%, respectively [ 33 ]. Among these reviewed patients with E. coli IE, the mortality and surgical intervention rates were 21% (7/33) and 42% (14/33), respectively [ 10 – 16 , 18 , 20 , 23 , 25 , 29 , 30 , 32 ]. Almost half of the patients (4/7) with fatal E. coli IE died within 1 month of hospitalization [ 11 – 13 , 16 , 29 ].…”

“…Prosthetic valve replacement was performed in eight patients (four AV and four MV replacements) [ 14 – 16 , 20 , 23 , 25 ], and MV annuloplasty was performed in one patient [ 16 ]. Resection of the infected valve leaflets without valve replacement was performed in two patients and was mainly done only in patients with tricuspid or pulmonary valve endocarditis [ 10 , 18 ]. In three patients, details of the surgical procedure were unclear [ 30 ].…”