Relapsing tricuspid valve endocarditis by multidrug-resistant Pseudomonas aeruginosa in 11 years: tricuspid valve replac
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CASE REPORT
Open Access
Relapsing tricuspid valve endocarditis by multidrug-resistant Pseudomonas aeruginosa in 11 years: tricuspid valve replacement with an aortic valve homograft Min-Seok Kim1, Hyoung Woo Chang1, Seung-Pyo Lee2, Dong Ki Kang3, Eui-Chong Kim3 and Ki-Bong Kim1*
Abstract Eleven years ago, a 27-year-old non-drug abuser woman was admitted to the hospital due to a burn injury. During the treatment, she was diagnosed with tricuspid valve infective endocarditis caused by multi-drug resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa). She underwent tricuspid valve replacement (TVR) using a bioprosthetic valve, followed by 6 weeks of meropenem antibiotic therapy. Ten years later, she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She underwent redo-TVR with a bioprosthetic valve and was treated with colistin and ciprofloxacin. Ten months later, she was again diagnosed with prosthetic valve infective endocarditis with MDR P. aeruginosa as a pathogen. She underwent a second redo-TVR with a tissue valve and was treated with colistin. Two months later, her fever recurred and she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She eventually underwent a third redo-TVR using an aortic valve homograft and was discharged from the hospital after additional 6 weeks’ of antibiotic therapy. All the strains of P. aeruginosa isolated from each event of infective endocarditis were analyzed by repetitive deoxyribonucleic acid sequence-based polymerase chain reaction (rep-PCR) deoxyribonucleic acid (DNA) strain typing to determine the correlation of isolates. All of the pathogens in 11 years were similar enough to be classified as the same strain, and this is the first case report of TVR using an aortic valve homograft to treat relapsing endocarditis. Keywords: Endocarditis, Prosthesis, Tricuspid valve surgery
Background Repeat infective endocarditis due to the same species is traditionally defined as a “relapse” if the second episode of infective endocarditis occurs within 6 months after the initial episode, but is defined as a “recurrence” if the second episode occurs after a period greater than 6 months from the previous episode. However, if a repeat episode of infective endocarditis is shown by molecular analysis to be caused by the same strain, it would be better defined as a “relapse” regardless of the time duration between episodes [1].
* Correspondence: [email protected] 1 Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Full list of author information is available at the end of the article
Case presentation Eleven years ago, a 27-year-old non-drug abuser woman was hospitalized due to a major burn injuring 55 % of her total body surface area. During her hospital treatment, she developed a sustained fever. Blood cultures revealed multi-drug resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) bacteremia. Her fever did not subside in
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