'TAVR Infected Pseudomonas Endocarditis': a case report.

Area of Science:

• Infectious Diseases
• Cardiology
• Medical Microbiology

Background:

• Pseudomonas aeruginosa (P. aeruginosa) is an uncommon cause of infective endocarditis (IE), typically affecting intravenous drug users.
• Infections in non-intravenous drug users are rare, but increasing reports link P. aeruginosa to cardiovascular implantable electronic devices and prosthetic heart valves.

Observation:

• An 89-year-old male with a history of transcatheter aortic valve replacement (TAVR) presented with recurrent P. aeruginosa bloodstream infections.
• Transthoracic echocardiogram revealed vegetation on the TAVR, and brain MRI showed multiple infarcts consistent with emboli.
• The patient had comorbidities precluding surgical valve replacement and allergies to common fluoroquinolones.

Findings:

• Medical management with long-term suppressive therapy using delafloxacin, a newer fluoroquinolone, was initiated.
• The patient tolerated delafloxacin well, achieving negative blood cultures and clinical improvement.
• This approach was chosen due to the patient's inability to undergo surgery and fluoroquinolone allergies.

Implications:

• This case highlights the successful use of delafloxacin for P. aeruginosa IE in a patient unsuitable for surgery.
• Long-term suppressive antibiotic therapy may be a viable option for managing prosthetic valve endocarditis when surgical intervention is contraindicated.
• It underscores the importance of considering alternative treatment strategies for rare P. aeruginosa IE cases.