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Serratia marcescens Endocarditis: A Case Report and Literature Review
Ana Isabel Ferreira1, Fernando Oliveira E Silva2, Jorge Reis3
1Department of Internal Medicine. Centro Hospitalar Universitário de São João. Porto. Portugal.
Abstract:
Serratia marcescens is a rarely implicated agent in endocarditis. We describe a case of a patient that underwent aortic and mitral valve replacement for Streptococcus agalactiae endocarditis. Four months later, he was readmitted with an ischemic stroke and fever. Physical examination and repetitive transthoracic echocardiogram were unremarkable. The initial blood cultures were negative. Due to sustained fever, vancomycin, gentamicin and piperacillin-tazobactam were initiated. On subsequent blood cultures, Serratia marcescens was isolated and antibiotics switched to ertapenem and gentamicin. In addition to cerebral emboli, a splenic embolus was found. The PET/CT revealed an abnormal hypercaptation in the mitral bioprosthesis. The patient was treated for six weeks. There are no current specific recommendations regarding the treatment of Serratia marcescens endocarditis. It is widely accepted that treatment should be prolonged and include a combination of antimicrobial agents. Morbidity and mortality are high, particularly when there's the need for surgical replacement. In this case, however, the patient ended-up only requiring medical treatment due to the favourable response.
Insights
Serratia marcescens endocarditis is rare but serious. This case highlights successful medical management of Serratia marcescens endocarditis with ertapenem and gentamicin, avoiding surgery.
Area of Science:
- Infectious Diseases
- Cardiology
- Critical Care Medicine
Background:
- Serratia marcescens is an uncommon cause of infective endocarditis.
- This report details a patient with a history of Streptococcus agalactiae endocarditis who developed subsequent Serratia marcescens endocarditis.
Approach:
- A patient with recurrent endocarditis underwent diagnostic workup including blood cultures and PET/CT.
- Treatment involved a switch to ertapenem and gentamicin for Serratia marcescens infection.
Key Points:
- Serratia marcescens endocarditis presented with ischemic stroke and splenic emboli.
- Positron Emission Tomography/Computed Tomography (PET/CT) identified abnormal hypercaptation in the mitral bioprosthesis.
- The patient responded favorably to a six-week course of ertapenem and gentamicin, avoiding repeat surgery.
Conclusions:
- While Serratia marcescens endocarditis carries high morbidity and mortality, medical management can be successful.
- Prolonged combination antimicrobial therapy is generally recommended for Serratia marcescens endocarditis.
- This case suggests that prompt diagnosis and appropriate antibiotic selection can lead to favorable outcomes even in complex endocarditis cases.
