Recurrent Infective Endocarditis of the Native Aortic
Valve due to ESBL Producing Escherichia coli (E coli) after
Therapeutic ERCP
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Mihaela Lupse1, Mirela Flonta2, Monica Straut3, Codruta Romanita Usein3, Marcel Tantau1, Adela Serban1
1) University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca
2) Hospital of Infectious Diseases, Cluj-
Napoca;
3) Cantacuzino Institute, Bucharest, Romania
Abstract
We describe the first case of ESBL producing E coli
endocarditis of the native aortic valve in which prophylaxis
was performed according to currently available guidelines. A
75 year-old woman presented at our emergency department
with a two week complaint of fever, fatigue, anorexia,
diffuse abdominal pain after ERCP therapeutic. The initial
laboratory examinations showed increased levels of ESR,
CRP, fibrinogen, alkaline phosphatase, gammaGT, aspartate
aminotransferase, alanine aminotransferase and direct
fraction of bilirubin. Two blood cultures were positive
for ESBL-producing E coli. The abdominal sonography
revealed intrahepatic biliary tree dilation, cholecystectomy
and minimal aerobilia in the left liver lobe. A transthoracic
echocardiogram showed a small vegetation adherent to the
aortic valve and a moderate amount of aortic and mitral
regurgitation. Treatment with imipenem/cilastatin for 35
days was performed with a favorable outcome. During this
period she underwent endoscopic metal stenting to replace
the plastic tube. The patient was discharged after 40 days
of hospitalization. Conclusion: Patients with high risk also
for endocarditis and infections or bowel colonization with
multiple drug resistant Enterobacteriaceae such as ESBLproducing
E coli that have undergone multiple and repetitive
therapeutic procedures are at risk for endocarditis with this
type of bacteria. Prophylaxis and therapy with appropriate
antibiotics must be considered in these patients.
Key Words
Endoscopic retrograde cholangio-pancreatography
- therapeutic endoscopy - bacteraemia - cardiovascular
complications - stents.
