Bridging Molecular and Clinical Sciences to Achieve the Best Treatment of Enterococcus faecalis Endocarditis

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Enterococcus faecalis (E. faecalis) is a commensal bacterium causing infections in surgical sites, urinary tract, and blood.
• E. faecalis infections disproportionately affect the elderly, often linked to degenerative valvular disease, invasive procedures, and medical devices.
• Bacterial characteristics like pili activity and biofilm formation contribute to resistance against antibiotic therapies, complicating treatment, especially for endocarditis.

Purpose of the Study:

• To present a case study of E. faecalis endocarditis in an octogenarian with a TAVI valve.
• To review literature and identify essential treatment algorithms for E. faecalis endocarditis in complex cases.
• To address diagnostic challenges posed by varied presentations and generalized symptoms of E. faecalis infections.

Main Methods:

• Case report of an octogenarian patient with TAVI valve and E. faecalis endocarditis.
• Comprehensive literature review focusing on treatment strategies for E. faecalis endocarditis.
• Analysis of diagnostic challenges and management complexities in elderly patients.

Main Results:

• The case study illustrates a real-world scenario of E. faecalis endocarditis in a vulnerable patient population.
• Literature review identified emerging challenges in managing antibiotic-resistant E. faecalis strains.
• Transcatheter therapies add complexity to treatment decisions for patients unsuitable for surgery.

Conclusions:

• E. faecalis endocarditis presents diagnostic and therapeutic challenges, particularly in elderly patients with prosthetic valves.
• Effective management requires understanding bacterial resistance mechanisms and adapting treatment algorithms.
• Further research into optimal treatment strategies for resistant E. faecalis infections is crucial.