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Gram-negative endocarditis following cystoscopy
Insights
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.
- 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.
Abstract:
Patients with bacteriuria are at risk for local and distant infectious complications at the time of urologic procedures. The American Heart Association recommends that penicillin and streptomycin be given prophylactically to patients with rheumatic or congenital heart disease without reference to the presence or absence of bacteriuria. A patient with unrecognized calcification of the mitral annulus who underwent cystoscopy for evaluation of urinary retention is reported. Although bacteriuria was present preoperatively antibiotics were not given. Subsequently, Serratia marcescens and possibly Proteus morgani mitral valve infection developed and the patient died. Calcification of the mitral valve annulus and an extensive urinary tract infection were identified at autopsy. This case suggests that calcification of the mitral annulus may be an endocarditis risk factor. The spectrum of prophylactic antibiotic coverage given at the time of urologic procedures to patients with congenital or aquired heart disease, including calcification of the mitral annulus, should include whatever organisms are present in the urine.