Discussion: Patients with PVE typically present with fevers, chills, shortness of breath, and pleuritic chest pain which was not seen in this case. However, additional cardiac testing was necessary due to the identification of an uncommon Coagulase negative Staphylococcus species (CoNS)-positive blood culture, specifically with Staphylococcus haemolyticus. Given the vegetation’s size and time since valve replacement, this pathogen was likely acquired from intraoperative contamination along with the patient’s comorbidities compromising her ability to clear the infection. This case emphasizes the importance of considering the etiology behind bacteremia and PVE. Identifying patient risk factors and being cautious about the sources of contamination could prevent the complications associated with prosthetic valves. Further research should examine the efficacy of preventive strategies, such as risk stratification and antibiotic pretreatment against PVE within the clinical setting.
presentation of PVE due to Staphylococcus haemolyticus, a coagulase-negative staphylococci (CoNS), which accounts for 12% of PVE. Case: An 84 year old female with hypertension, hyperlipidemia, coronary artery disease, chronic diastolic heart failure, and a history of an aortic valve replacement with left atrial myxoma status post resection ten months ago, presented for a fall due to generalized weakness. She was afebrile, but hypotensive with a systolic in the 90’s on presentation. She denied any fevers, chest pain, or shortness of breath, but had dysuria for the past two days. Urine studies were positive for Klebsiella bacteriuria. Blood cultures were positive for Staphylococcus haemolyticus. The patient was started on antibiotics and underwent echocardiographic assessment which was remarkable for a 1cm x 0.7 cm mobile vegetation on the aortic valve. The patient was evaluated by cardiothoracic surgery, but given her age and functional status, they recommended medical treatment with a long course of antibiotics.
AN INTERESTING CASE OF SHEWANELLA ALGAE BACTEREMIA. Arati Joshi, Seth Vignes; Louisiana State University, New Orleans, LA.
Introduction: Shewanella algae is a gram-negative bacillus found in marine habitats that rarely causes complex medical disease. This organism is found in aquatic environments and can be transmitted by exposure to contaminated water orally or via open wounds. Immunocompromised patients are more likely to have severe pathogenic complications from exposure to this microbe. Case: A 76-year-old male presented after a fall. The fall occurred as he was trying to get up after he had been unable to walk for three months. Upon arrival, he had altered mental status, weakness, diffuse edema and lower extremity wounds and met sepsis criteria. Cultures were obtained and broad- spectrum antibiotics (vancomycin, cefepime, and metronidazole) were initiated. On exam, his bilateral feet were cold to touch but pink with sloughing of the skin. However, pulses were non-palpable in his dorsalis pedis, posterior tibial, or popliteal arteries. Surgery was consulted and recommended bilateral below-the-knee (BKA) amputations. However, the patient wanted to try conservative
measures. His blood cultures grew Shewanella algae in all bottles. The infectious disease service changed his antibiotic regimen to piperacillin- tazobactam. Additional history from the patient’s wife revealed that the patient was washing himself with tap water and using a make-shift bedside commode at home due to his inability to walk. His mental status continued to improve while on the new antibiotic regimen. Repeat blood cultures cleared while on piperacillin-tazobactam. While his mental status improved, his leukocytosis and kidney function continued to worsen, likely due to poor source control. Upon further discussion, the patient was amenable to amputation. Unfortunately, with the delay in surgery and worsening multi- organ failure, the patient eventually coded. Return of spontaneous circulation was obtained. The patient was intubated and placed on respiratory and pressor support. In a shared-decision-making process with the patient’s wife, the patient was transitioned to comfort care and passed shortly after.
Discussion: This case illustrates the clinical
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