Serratia marcescens Tricuspid Valve Vegetation and Successful Use of the AngioVac® System

Sean M Winkle,Jeremy B Miller,Salem Gaballa,Areeka Memon,Ryan Curfiss

doi:10.7759/cureus.10010

Abstract

Serratia marcescens bacteremia is common in patient populations with a history of intravenous drug use (IVDU), but it rarely causes infective endocarditis. We are reporting a 27-year-old female with a medical history significant for IVDU and hepatitis C virus infection who presented to the emergency department complaining of fever and shortness of breath. Computed tomography of the chest with intravenous (IV) contrast revealed extensive bilateral pulmonary infiltrates with multiple cavitary lesions. The patient was treated with IV vancomycin and piperacillin/tazobactam. Blood culture grows methicillin-sensitive Staphylococcus aureus (MSSA) and S. marcescens, both sensitive to cefepime/meropenem. Transesophageal echocardiogram revealed 3.4 x 2 cm tricuspid valve vegetation. Cardiothoracic surgery was consulted, who recommended transcatheter aspiration with the AngioVac® system (AngioDynamics Inc., Latham, NY). Post-procedure transesophageal echocardiogram revealed a significant reduction of vegetation size. Vegetation tissue culture grew MSSA and S. marcescens. The repeated blood culture revealed no growth, and the patient significantly improved clinically. She completed a six-week course of IV meropenem as an inpatient until she was discharged home.

Highlights

Infective endocarditis (IE) is an infection of the inner lining of the heart and generally involves the heart valves and may occur at septal defect sites, on chorda tendinea, and on the mural endocardium
For an infection to be sustained there must be irregularities of the endocardium to allow for bacterial adherence, adhesion must occur, and there should be survival of the adhered bacteria
The endocardium can become more habitable by bacteria through trauma to the tissue leading to deposition of platelets and fibrin

Summary

Introduction

Infective endocarditis (IE) is an infection of the inner lining of the heart and generally involves the heart valves and may occur at septal defect sites, on chorda tendinea, and on the mural endocardium. A 27-year-old female with a past medical history of IVDU and untreated hepatitis C viral infection presented with subjective fever and chills for one week. She had complaints of generalized weakness, fatigue, and nausea. A transesophageal echocardiogram (TEE) revealed multiple vegetations on the atrial aspect of the tricuspid valve (Figure 2), the largest measuring 3.4 x 2.0 cm on the posterior leaflet and 3.2 x 1.1 cm on the anterior leaflet. The post-procedural TEE showed significant reduction of vegetation size on the tricuspid valve (Figure 3). Axial view of chest CT (lung window) revealing multiple bilateral cavitary lesions due to septic emboli likely from tricuspid valve vegetations. The patient required an extended six-week course of IV meropenem (per susceptibilities) prior to discharge with follow up for continued monitoring of sequelae due to septic emboli

Discussion

Conclusions

Disclosures