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Endocarditis Caused by Multiply Resistant Bacteroides fragilis: Case Report and Review.
Olivier Lortholary1, Annie Buu-Hoï, Isabelle Podglajen
1Service de Microbiologie, Hôpital Broussais, Paris.
Summary
This study reports a fatal case of prosthetic valve endocarditis caused by the antibiotic-resistant Bacteroides fragilis fragilis, linked to ovarian cancer. This highlights the serious, often fatal, outcomes of such infections, especially with resistant strains.
Area of Science:
- Infectious Diseases
- Cardiology
- Oncology
Background:
- Prosthetic valve endocarditis (PVE) is a severe complication following cardiac valve replacement surgery.
- Bacteroides species, particularly Bacteroides fragilis, are increasingly recognized as significant pathogens in intra-abdominal infections but are less commonly associated with endocarditis.
- Antibiotic resistance in Bacteroides species poses a therapeutic challenge, complicating the management of serious infections.
Purpose of the Study:
- To report a rare case of fatal prosthetic aortic valve endocarditis caused by a multidrug-resistant strain of Bacteroides fragilis fragilis.
- To review and analyze previously reported cases of endocarditis caused by Bacteroides species.
- To highlight the clinical presentation, associated conditions, and outcomes of Bacteroides-associated endocarditis.
Main Methods:
- Case presentation of a 78-year-old woman with fatal endocarditis.
- Literature review of 17 previously described cases of endocarditis caused by Bacteroides spp.
- Analysis of antibiotic susceptibility patterns of the causative B. fragilis strain.
- Comparison of clinical features and outcomes across all 18 reported cases.
Main Results:
- The patient developed fatal endocarditis of her prosthetic aortic valve due to Bacteroides fragilis fragilis, associated with ovarian carcinoma.
- The isolated B. fragilis strain exhibited resistance to multiple antibiotics, including beta-lactam agents and combinations with beta-lactamase inhibitors.
- In a review of 18 cases (including the current one), the mean age was 50.3 years, the gastro-intestinal tract was the most common associated disease site, embolism occurred in 10 cases, and 8 patients died.
- Previous isolates of Bacteroides spp. causing endocarditis showed typical antibiotic susceptibility patterns, unlike the current multidrug-resistant strain.
Conclusions:
- Bacteroides fragilis endocarditis, especially involving prosthetic valves and associated with malignancy, can lead to fatal outcomes.
- The emergence of multidrug-resistant Bacteroides strains, like the one identified in this case, presents significant therapeutic challenges in managing endocarditis.
- Clinicians should maintain a high index of suspicion for Bacteroides endocarditis in patients with relevant risk factors and be aware of the increasing threat of antibiotic resistance.