1
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Essien F, Patterson S, Estrada F, Wall T, Madden J, McGarvey M. ‘TAVR Infected Pseudomonas Endocarditis’: a case
report. Ther Adv Infect Dis 2022; 9:20499361221138459. [PMCID: PMC9716447 DOI: 10.1177/20499361221138459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/26/2022] [Indexed: 12/03/2022] Open
Abstract
Pseudomonas aeruginosa (P. aeruginosa) rarely
causes infective endocarditis (IE), previously reported for approximately 3% of
all patients with IE.1 Most commonly, the infection occurs in
intravenous drug users (IVDU) as right-sided endocarditis, noting presentations
of P. aeruginosa IE without history of intravenous drug to
be extremely rare, finding only a few cases reported in the literature. However
there are increasing reports of cardiovascular implantable electronic
device–related and prosthetic heart valve infections caused by this pathogen in
non-IVDUs.2 This report will focus on the clinical presentation,
management, and outcome of P. aeruginosa endocarditis in an
89-year-old patient with a transcatheter aortic valve replacement (TAVR).
Medical management was pursued due to the patient’s underlying comorbidities.
Long-term suppressive antibiotic therapy with delafloxacin was successful in
maintaining negative blood cultures, despite an allergy to levofloxacin and
ciprofloxacin.
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Affiliation(s)
| | - Shane Patterson
- Division of Infectious Disease, Department of
Internal Medicine, David Grant Medical Center, Travis Air Force Base, Travis
AFB, CA, USA
| | - Fernando Estrada
- Department of Pharmacy, David Grant Medical
Center, Travis Air Force Base, Travis AFB, CA, USA
| | - Timothy Wall
- Department of Internal Medicine, David Grant
Medical Center, Travis Air Force Base, Travis AFB, CA, USA
| | - John Madden
- Department of Radiology, David Grant Medical
Center, Travis Air Force Base, Travis AFB, CA, USA
| | - Michael McGarvey
- Division of Cardiology, Department of Internal
Medicine, David Grant Medical Center, Travis Air Force Base, Travis AFB, CA,
USA
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2
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Al-Terki H, Mügge A, Gotzmann M. Infective endocarditis of a left atrial appendage closure device: a case report and literature review. Eur Heart J Case Rep 2022; 6:ytac434. [DOI: 10.1093/ehjcr/ytac434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/06/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
Abstract
Background
Due to advances in interventional cardiology in recent years, more and more patients are currently receiving cardiac devices, with a subsequent increase in the number of patients with device-associated endocarditis. Device-associated endocarditis is a life-threatening disease with special diagnostic and therapeutic challenges. Interventional devices for left atrial appendage (LAA) closure have been available for several years. However, there have been very few case reports of LAA closure device–associated endocarditis.
Case summary
An 83-year-old woman presented with fever and fatigue. She had a history of permanent atrial fibrillation and recurrent bleeding on oral anticoagulation. Consequently, the patient underwent interventional LAA closure ∼20 months earlier. Blood cultures grew Staphylococcus aureus. Transoesophageal echocardiography revealed an LAA closure device–associated mobile, echo-dense mass that was consistent with infectious vegetation in this clinical context. Intravenous antibiotic therapy was started, and our heart team recommended complete removal of the device, which the patient refused. The patient subsequently died as a result of progressive endocarditis and multiple pre-existing co-morbidities.
Discussion
Left atrial appendage occlusion device–associated endocarditis has rarely been reported. Due to the increase in LAA closure device implantation, device-associated endocarditis is expected to increase in the future. Transoesophageal echocardiography is required for correct diagnosis. Our case report suggests that an infection can occur long after implantation.
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Affiliation(s)
- Hani Al-Terki
- Cardiology and Rhythmology, University Hospital St Josef-Hospital Bochum, Ruhr University Bochum , Gudrunstraße 56, 44791 Bochum , Germany
| | - Andreas Mügge
- Cardiology and Rhythmology, University Hospital St Josef-Hospital Bochum, Ruhr University Bochum , Gudrunstraße 56, 44791 Bochum , Germany
| | - Michael Gotzmann
- Cardiology and Rhythmology, University Hospital St Josef-Hospital Bochum, Ruhr University Bochum , Gudrunstraße 56, 44791 Bochum , Germany
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3
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Affiliation(s)
- Luai Madanat
- Department of Internal Medicine, William Beaumont Hospital – Royal Oak, Royal Oak, Michigan
| | - Richard Bloomingdale
- Department of Cardiovascular Medicine, William Beaumont Hospital – Royal Oak, Royal Oak, Michigan
| | - Kuldeep Shah
- Department of Cardiovascular Medicine, William Beaumont Hospital – Royal Oak, Royal Oak, Michigan
| | - Amal Khalife
- Department of Infectious Disease, William Beaumont Hospital – Royal Oak, Royal Oak, Michigan
| | - David E. Haines
- Department of Cardiovascular Medicine, William Beaumont Hospital – Royal Oak, Royal Oak, Michigan
| | - Nishaki K. Mehta
- Department of Cardiovascular Medicine, William Beaumont Hospital – Royal Oak, Royal Oak, Michigan
- Oakland University School of Medicine. Rochester, Michigan
- University of Virginia, Charlottesville, Virginia
- Address reprint requests and correspondence: Dr Nishaki Mehta, Department of Cardiovascular Medicine, Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073.
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4
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Ward RC, McGill T, Adel F, Ponamgi S, Asirvatham SJ, Baddour LM, Holmes DR, DeSimone DC, DeSimone CV. Infection Rate and Outcomes of Watchman Devices: Results from a Single-Center 14-Year Experience. Biomed Hub 2021; 6:59-62. [PMID: 34179027 DOI: 10.1159/000516400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022] Open
Abstract
The Watchman device (WD) is a commonly used alternative strategy to oral anticoagulation for stroke risk reduction in patients with atrial fibrillation who have an increased bleeding risk. There are rare case reports of WD-related infection. Currently, there is no formal study that has systematically evaluated the incidence and outcomes WD-related infections. The objective of this study was to evaluate the incidence, risk factors, and outcomes for WD-associated infections in a single-center cohort over a 14-year period. All patients who underwent WD implantation over a 14-year study period (July 2004 through December 2018) comprised our cohort. Baseline characteristics, procedural data, and postimplantation events were identified through a retrospective chart review. Primary study outcomes included WD-related infection, other cardiovascular device-related infection, bacteremia, and mortality. A total of 181 patients (119 males; 65.7%) with a mean age of 75 years at implantation were included in the analysis. A total of 534.7 patient years of follow-up was accrued, with an average of 2.9 years per patient. The most common indications for implantation included gastrointestinal bleeding (56 patients; 30.9%) and intracerebral bleeding (51 patients; 28.2%). During the follow-up period, 37 (20.4%) patients died. Six developed evidence of bacteremia. Only 1 developed an implantable cardioverter defibrillator infection that required a complete system extraction. None of the cohort developed a WD-related device infection during the study period. We concluded that there is a low risk of WD-related infection even in the setting of a blood stream infection.
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Affiliation(s)
- Robert C Ward
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Trevon McGill
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fadi Adel
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shiva Ponamgi
- Division of Cardiology, Creighton University, Omaha, Nebraska, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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5
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Khan F, Sharma N, Ud Din M, Shirke S, Abbas S. Convexal Subarachnoid Hemorrhage Caused by Infective Endocarditis in a Patient with Advanced Human Immunodeficiency Virus (HIV): The Culprits and Bystanders. Am J Case Rep 2021; 22:e931376. [PMID: 33986239 PMCID: PMC8130978 DOI: 10.12659/ajcr.931376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Convexal subarachnoid hemorrhage (cSAH), a rare form of non-aneurysmal subarachnoid hemorrhage, is confined to cerebral convexities without extension into basal cisterns or ventricles. Typical presentation includes thunderclap/progressive headache or transient focal neurological symptoms; rare manifestations include seizures, intractable vomiting, or altered mental status. Here, we report the first case of convexal subarachnoid hemorrhage and multifocal ischemic lesions caused by infective endocarditis (IE) in a treatment-naïve advanced HIV patient. CASE REPORT A 52-year-old HAART-naïve, HIV-positive, African American man presented with altered mental status, shortness of breath, nonproductive cough, and generalized weakness. His past medical history was significant for congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (noncompliant with hemodialysis). Head computed tomography (CT) showed an isolated sulcal hemorrhage in the mid-left frontal lobe. Fluid-attenuated inversion recovery/gradient recalled echo sequences confirmed a hemorrhage in the left-mid-frontal sulcus, and diffusion-weighted imaging revealed multifocal bilateral ischemic lesions. Transesophageal echocardiography exhibited mitral valve vegetations. Multifocal ischemic lesions and cSAH caused by infectious endocarditis were confirmed. Initiation of intravenous vancomycin and piperacillin-tazobactam allowed the patient to have resolution of his altered mental status. A head CT 5 days later revealed the resolution of cSAH. CONCLUSIONS Infective endocarditis should be considered as an underlying etiology of cSAH, especially when present with multifocal ischemic lesions. Risk factors contributing to the development of cSAH in the IE patient population should be explored in future studies. HIV has not been previously reported in this subgroup and its prevalence should be considered. The prognosis for cSAH in relation to IE is generally favorable.
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Affiliation(s)
- Faisal Khan
- Department of Neurology, Sam Houston State University College of Osteopathic Medicine, Huntsville, TX, USA
| | - Neha Sharma
- Houston Medical Clerkship, Sugar Land, TX, USA
| | - Moin Ud Din
- Houston Medical Clerkship, Sugar Land, TX, USA
| | - Saloni Shirke
- Caribbean Medical University School of Medicine, Willemstad, Curacao, Netherlands Antilles
| | - Saima Abbas
- Department of Infectious Disease, Rockledge Regional Medical Center, Rockledge, FL, USA
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6
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Kleinecke C, Gloekler S, Meier B. Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation: an update on patient outcomes. Expert Rev Cardiovasc Ther 2020; 18:517-530. [DOI: 10.1080/14779072.2020.1794820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Caroline Kleinecke
- Cardiology, Internal Medicine Department, Klinikum Lichtenfels, Lichtenfels, Germany
| | - Steffen Gloekler
- Cardiology, Internal Medicine Department, Klinikum Hochrhein, Waldshut-Tiengen, Germany and Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
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7
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Abstract
The authors report a rare case of infected Watchman device 4 months after placement. A high index of suspicion allowed timely diagnosis of Watchman device infection. Transesophageal echocardiography led to diagnosis of an infected Watchman device. High clinical morbidity is associated with Watchman device endocarditis.
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Affiliation(s)
- Joseph Jensen
- Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Christina Thaler
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Retu Saxena
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Domenico Calcaterra
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jason Sanchez
- Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Quirino Orlandi
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Kevin M Harris
- Abbott Northwestern Hospital, Minneapolis, Minnesota.,Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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