PROSTHETIC VALVE INFECTIVE ENDOCARDITIS CAUSED BY SERRATIA MARCESCENS IN A PATIENT WITH SURGICAL WOUND INFECTION

Abstract

SESSION TITLE: Rare Pulmonary and Cardiac InfectionsSESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 01:35 pm - 02:35 pmINTRODUCTION: Infective endocarditis (IE) is most commonly caused by Staphylococcus and Streptococcus species. Serratia marcescens (S. marcescens) IE was infrequently described in literature and was mostly associated with intravenous drug use (IVDU). We report a case of S. marcescens prosthetic valve IE in a patient with a surgical wound infection.CASE PRESENTATION: a 57-year-old male with a past medical history of Bioprosthetic aortic valve replacement (AVR), popliteal artery aneurysm and thrombus status post stent placement, and left superficial femoral artery to posterior tibial artery bypass, who presented to the hospital with fever, chills, and purulent drainage from his left thigh incision. Six weeks prior to his presentation, the patient had undergone left sided femoropopliteal bypass with a graft. Vital signs upon presentation were notable for elevated temperature at 102.7 F, mild tachycardia with heart rate of 103. Physical examination showed surgical incision with some dehiscence and purulent fluid surrounded by erythema. A systolic murmur was heard over the left lower sternal border. Laboratory tests upon presentation were notable for leukocytosis and lactic acidosis. An ultrasound of the left thigh showed an 8.5 cm x 0.6 cm accumulation in the distal thigh. Blood cultures were drawn and patient was started on intravenous (IV) Vancomycin and Piperacillin/Tazobactam. Patient underwent incision and drainage of the left distal thigh collection. Admission blood cultures grew S. marcescens in 3/4 bottles. Antibiotics were switched to IV ciprofloxacin. As the patient had prosthetic valve, evaluation for IE with a transoesophageal echocardiogram (TEE) showed an aortic mass on his prosthetic valve with vegetation. Patient underwent AVR and aortic root repair. Post operative blood cultures and intra-operative cultures were negative. A broad spectrum bacterial PCR from the aortic valve vegetation returned positive for S. marcescens. Patient was eventually discharged on oral ciprofloxacin.DISCUSSION: S. marcescens is the most frequently isolated Serratia species in human infections and is implicated in various human infections including urinary tract infection, pneumonia, and bloodstream infection [1]. S. marcescens is an uncommon cause of IE. In the International Collaboration on Endocarditis (ICE) prospective cohort, only 4 out of 2761 cases of endocarditis were caused by S. marcescens, which represents 0.14% of the total[2]. Serratia IE has been mostly associated with intravenous drug use[3]. Our case highlights the occurrence of Serratia IE, with the most likely source being the vascular graft and surgical site infection in a patient with no history of IVDU.CONCLUSIONS: S. marcescens is an uncommon cause of IE. It is mostly seen in patients with a history of IVDU. However, other risk factors, such as surgical site infections and infected vascular grafts, should always be taken into consideration.Reference #1: Mahlen SD. Serratia infections: from military experiments to current practice. Clin Microbiol Rev. 2011;24(4):755-791. doi:10.1128/CMR.00017-11Reference #2: Morpeth S, Murdoch D, Cabell CH, et al. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med. 2007;147(12):829-835. doi:10.7326/0003-4819-147-12-200712180-00002Reference #3: Mills J, Drew D. Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse. Ann Intern Med. 1976 Jan;84(1):29-35. doi: 10.7326/0003-4819-84-1-29. PMID: 1106290.DISCLOSURES: No relevant relationships by Suha Abu khalafNo relevant relationships by Omar HusseinNo relevant relationships by Mahmoud MansourNo relevant relationships by SACHIN PATILNo relevant relationships by Baraa Saad SESSION TITLE: Rare Pulmonary and Cardiac Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: Infective endocarditis (IE) is most commonly caused by Staphylococcus and Streptococcus species. Serratia marcescens (S. marcescens) IE was infrequently described in literature and was mostly associated with intravenous drug use (IVDU). We report a case of S. marcescens prosthetic valve IE in a patient with a surgical wound infection. CASE PRESENTATION: a 57-year-old male with a past medical history of Bioprosthetic aortic valve replacement (AVR), popliteal artery aneurysm and thrombus status post stent placement, and left superficial femoral artery to posterior tibial artery bypass, who presented to the hospital with fever, chills, and purulent drainage from his left thigh incision. Six weeks prior to his presentation, the patient had undergone left sided femoropopliteal bypass with a graft. Vital signs upon presentation were notable for elevated temperature at 102.7 F, mild tachycardia with heart rate of 103. Physical examination showed surgical incision with some dehiscence and purulent fluid surrounded by erythema. A systolic murmur was heard over the left lower sternal border. Laboratory tests upon presentation were notable for leukocytosis and lactic acidosis. An ultrasound of the left thigh showed an 8.5 cm x 0.6 cm accumulation in the distal thigh. Blood cultures were drawn and patient was started on intravenous (IV) Vancomycin and Piperacillin/Tazobactam. Patient underwent incision and drainage of the left distal thigh collection. Admission blood cultures grew S. marcescens in 3/4 bottles. Antibiotics were switched to IV ciprofloxacin. As the patient had prosthetic valve, evaluation for IE with a transoesophageal echocardiogram (TEE) showed an aortic mass on his prosthetic valve with vegetation. Patient underwent AVR and aortic root repair. Post operative blood cultures and intra-operative cultures were negative. A broad spectrum bacterial PCR from the aortic valve vegetation returned positive for S. marcescens. Patient was eventually discharged on oral ciprofloxacin. DISCUSSION: S. marcescens is the most frequently isolated Serratia species in human infections and is implicated in various human infections including urinary tract infection, pneumonia, and bloodstream infection [1]. S. marcescens is an uncommon cause of IE. In the International Collaboration on Endocarditis (ICE) prospective cohort, only 4 out of 2761 cases of endocarditis were caused by S. marcescens, which represents 0.14% of the total[2]. Serratia IE has been mostly associated with intravenous drug use[3]. Our case highlights the occurrence of Serratia IE, with the most likely source being the vascular graft and surgical site infection in a patient with no history of IVDU. CONCLUSIONS: S. marcescens is an uncommon cause of IE. It is mostly seen in patients with a history of IVDU. However, other risk factors, such as surgical site infections and infected vascular grafts, should always be taken into consideration. Reference #1: Mahlen SD. Serratia infections: from military experiments to current practice. Clin Microbiol Rev. 2011;24(4):755-791. doi:10.1128/CMR.00017-11 Reference #2: Morpeth S, Murdoch D, Cabell CH, et al. Non-HACEK gram-negative bacillus endocarditis. Ann Intern Med. 2007;147(12):829-835. doi:10.7326/0003-4819-147-12-200712180-00002 Reference #3: Mills J, Drew D. Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse. Ann Intern Med. 1976 Jan;84(1):29-35. doi: 10.7326/0003-4819-84-1-29. PMID: 1106290. DISCLOSURES: No relevant relationships by Suha Abu khalaf No relevant relationships by Omar Hussein No relevant relationships by Mahmoud Mansour No relevant relationships by SACHIN PATIL No relevant relationships by Baraa Saad