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Isolated Pulmonary Valve Endocarditis Caused by Enterococcus faecalis-Facing the Unpredictable.
Andrei Vâţă1,2, Isabela Ioana Loghin1,2, Radu Ștefan Miftode3,4
1Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
Antibiotics (Basel, Switzerland)
|March 28, 2025
Summary
This case study highlights a rare instance of isolated pulmonary valve endocarditis caused by Enterococcus faecalis. The pathogen developed ampicillin resistance during treatment, underscoring the need for careful antibiotic stewardship.
Area of Science:
- Cardiology
- Infectious Diseases
- Microbiology
Background:
- Infective endocarditis (IE) is a serious heart lining infection.
- Right-sided IE commonly involves the tricuspid valve, often linked to IV drug use or devices.
- Enterococcus faecalis is a prevalent healthcare pathogen with increasing antibiotic resistance.
Observation:
- A 69-year-old man presented with isolated pulmonary valve endocarditis (IPE).
- The patient had no typical risk factors like IV drug use, intracardiac devices, or recent dental procedures.
- The Enterococcus faecalis strain was initially susceptible to ampicillin.
Findings:
- The E. faecalis strain acquired ampicillin resistance during high-dose ampicillin and gentamicin therapy.
- This resistance led to the need for cardiac surgery and extended antibiotic treatment.
- Isolated pulmonary valve endocarditis (IPE) is a rare clinical presentation.
Implications:
- Heightened clinical suspicion and diagnostic evaluation are crucial for rare IE presentations.
- Emergence of ampicillin resistance in E. faecalis during treatment poses a significant therapeutic challenge.
- Judicious antibiotic stewardship is essential for optimizing patient outcomes in infective endocarditis.