Serratia marcescens and other non-AACEK GNB endocarditis: A case report and review of literature

摘要

BACKGROUND Non-Aggregatibacter aphrophilus,Aggregatibacter actinomycetemcomitans,Cardiobacterium hominis,Eikenella corrodens,Kingella spp.(non-AACEK)gramnegative bacilli(GNBs)are an infrequent and challenging cause of endocarditis associated previously with mainly intravenous drug use.Currently,this pathology has increasingly become a healthcare-associated issue.Current guidelines do not clearly define the management of non-AACEK GNB endocarditis due to a lack of prospective trials.We review characteristics,outcomes and treatment of non-AACEK GNB endocarditis,in particular Serratia marcescens endocarditis.CASE SUMMARY We describe the case report of a 46-year-old man who presented to the emergency department with high-grade fever and a purulent exudate on an intracardiac device site.Serratia marcescens mitral valve endocarditis as a consequence of complicated generator pocket infection was diagnosed.The patient was treated with complete device removal and a long course of broadspectrum antibiotics for 6 wk after surgery with intravenous piperacillintazobactam and ciprofloxacin,which was later switched to oral ciprofloxacin and sulfamethoxazole-trimethoprim.The patient had complete resolution of symptoms and inflammatory parameters at the end of the treatment and at follow-up.CONCLUSION Long-term dual-antibiotic therapy containing a beta-lactam is indicated for most non-AACEK GNB endocarditis, whereas valve surgery may not be necessary inall patients.