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Published on: June 4, 2012

Infective endocarditis caused by multidrug-resistant Streptococcus mitis in a combined immunocompromised patient: an

Natsuko Matsui1, Makoto Ito, Hitoshi Kuramae

  • 1Department of Pathology and Laboratory Medicine, Kariya Toyota General Hospital, 5-15 Sumiyoshi, Kariya, Aichi, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|September 12, 2012
PubMed

Insights

A rare autopsy case highlights infective endocarditis caused by multidrug-resistant Streptococcus mitis in an immunocompromised patient. This finding underscores the need for careful antibiotic selection in vulnerable populations.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Immunology

Background:

  • Infective endocarditis (IE) is a serious infection, particularly when caused by antibiotic-resistant bacteria.
  • Streptococcus mitis, typically commensal, can cause invasive disease in immunocompromised individuals.
  • Patient presented with multiple risk factors for compromised immunity, including autoimmune hemolytic anemia, post-splenectomy status, prolonged steroid therapy, and IgA deficiency.

Observation:

  • An autopsy revealed infective endocarditis attributed to a multidrug-resistant strain of Streptococcus mitis.
  • The isolated S. mitis strain exhibited broad resistance to common antibiotic classes: penicillin, cephalosporins, carbapenem, macrolides, and fluoroquinolone.
  • The patient had a history of recurrent bacterial infections and extensive prior antibiotic treatment.

Findings:

  • This case demonstrates a fatal outcome of IE caused by a highly resistant S. mitis strain in a complex patient.
  • The multidrug resistance in S. mitis was likely driven by recurrent infections and previous antibiotic exposure.
  • The study highlights the increasing challenge of treating invasive S. mitis infections in chronically immunocompromised patients.

Implications:

  • Clinicians must consider the possibility of multidrug-resistant S. mitis in immunocompromised patients with IE.
  • Judicious antibiotic stewardship is crucial to prevent the emergence and spread of antibiotic resistance.
  • Development of novel therapeutic strategies may be necessary for invasive infections caused by resistant S. mitis strains.

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