Bacterial endocarditis following a minor burn injury. Case report and review

Abstract

To date all reports and reviews have stated that bacterial endocarditis, when it occurs, does so following a major burn injury. The incidence of this in one series is reported at 2% [Baskin JW, Rosenthal A, Pruit BA. Acute bacterial endocarditis: a silent source of sepsis in the burns patient. Ann Surg 1976;184:618–621.]. We present a case of bacterial endocarditis in a patient with a total burn area of less than 1%. Several reports of endocarditis following minor skin procedures are in the literature [Jeffreys DB, Smith S, Brennand-Roper DA, Curry PVL. Acupuncture needles as a cause of bacterial endocarditis. Br Med J 1983;287:326–327; Lee RJE, McIlwain JC. Subacute bacterial endocarditis following ear puncture. Int J Cardiol 1985;7:62–63; Scheel O, Sundsfjord A, Lunde P, Andersen BM. Endocarditis after acupuncture and injection-treatment by a natural healer. JAMA 1992;267:56.] and demonstrate how seemingly innocuous procedures such as minor burn surgery can be complicated by cardiac infection. Staphylococcal skin or wound infections are an important aetiological factor and have been implicated in up to 43% of cases of endocarditis in intravenous drug abusers [Pandis IP, Kotler MN, Mintz GS, Ross J, Weber J. Clinical and echocardiographic correlations in right heart endocarditis. Int J Cardiol 1984;6(1):17–34.]. There has been an increase in the incidence of methicillin resistant strains of Staphylococcus aureus (MRSA) infection in burns units [Lesseva MI, Hadjiiski OG. Staphylococcal infections in the Sofia Burn Centre. Burns 1996;22:279–282; Reardon CM, Brown TPLaH, Stephenson AJ, Freedlander E. Methicillin-resistant Staphylococcus aureus in burns patients: why all the fuss? Burns 1998;24:393–397.] and this has implications for; hospital admission, screening, patient handling and antibiotic prescribing. However a recent study suggests that methicillin resistance does not lead to a greater degree of morbidity or mortality in burns patients [Reardon CM, Brown TPLaH, Stephenson AJ, Freedlander E. Methicillin-resistant Staphylococcus aureus in burns patients-why all the fuss? Burns 1998;24:393–397.]. A high index of suspicion for bacterial endocarditis should exist for any burns patient, regardless of burn size, who becomes unwell and has positive blood cultures.