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Gram-negative endocarditis following cystoscopy.

R Marier, A J Valenti, J A Mardi

    The Journal of Urology
    |January 1, 1978
    PubMed
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    Patients undergoing urologic procedures with bacteriuria face infection risks. Prophylactic antibiotics for heart conditions should cover urinary pathogens, especially with mitral annulus calcification, a potential endocarditis risk factor.

    Area of Science:

    • Cardiology
    • Infectious Diseases
    • Urology

    Background:

    • Patients with bacteriuria are susceptible to infectious complications during urologic procedures.
    • Current guidelines recommend prophylactic antibiotics for patients with heart disease but do not universally consider bacteriuria status.
    • Calcification of the mitral valve annulus is a recognized risk factor for infective endocarditis.

    Observation:

    • A case is presented of a patient with unrecognized mitral annulus calcification undergoing cystoscopy for urinary retention.
    • The patient had pre-existing bacteriuria but did not receive preoperative antibiotics.
    • Post-procedure, the patient developed a severe mitral valve infection by Serratia marcescens and possibly Proteus morgani, leading to death.

    Findings:

    • Autopsy revealed mitral valve annulus calcification and a significant urinary tract infection.

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  • This case highlights mitral annulus calcification as a potential risk factor for endocarditis.
  • The patient's death was attributed to the disseminated infection originating from the urinary tract.

    • Implications:

    • Prophylactic antibiotic regimens for urologic procedures in patients with heart disease, including mitral annulus calcification, should be broadened.
    • Antibiotic selection must account for potential urinary tract pathogens identified in patients.
    • Enhanced vigilance and tailored prophylaxis are crucial to prevent severe infectious complications in at-risk populations.