The novel use of oral antibiotic monotherapy in prosthetic valve endocarditis caused by Finegoldia magna : a case study
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(2019) 14:170
CASE REPORT
Open Access
The novel use of oral antibiotic monotherapy in prosthetic valve endocarditis caused by Finegoldia magna: a case study Siobhan Chien1* , David Gorman1, Charilaos-Panagiotis Koutsogiannidis1, Ramanish Ravishankar2, Ganesh Kamath3 and Vipin Zamvar1
Abstract Background: Finegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature. Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis. Case presentation: This case report focuses on a 52-year-old gentleman, who presented with initially culturenegative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up. Conclusions: This case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery. Keywords: Finegoldia magna, Prosthetic valve endocarditis, Oral antibiotics, Administration, Cardiac surgical procedures, Treatment outcome, Infective endocarditis
Background Finegoldia magna (previously known as Peptostreptococcus magnus) is the most commonly isolated Grampositive anaerobic cocci (GPAC) from clinical specimens, and is a normal commensal of human mucocutaneous surfaces [1, 2]. However, it remains a rare and unusual microbe implicated in the pathogenesis of infective endocarditis. * Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK Full list of author information is available at the end of the article
Although relatively rare, infective endocarditis carries a substantial morbidity and mortality risk, with current guidelines advocating the administration of prolonged, parenteral bactericidal therapy for complete infection eradication [3]. The recent publication of the Partial Oral Treatment of Endocarditis (POET) trial has recently p
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