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Infective endocarditis due to Stenotrophomonas (Xanthomonas) maltophilia
R G Munter1, A M Yinnon, Y Schlesinger
1Department of Medicine and Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Abstract:
Stenotrophomonas maltophilia (formerly Xanthomonas maltophilia) is a gram-negative bacillus increasingly associated with serious nosocomial infections. Here, the case of a 69-year-old female patient who developed prosthetic valve endocarditis associated with this organism is described. A review of the literature revealed only 18 previous reports; eight involved native valves, the remainder prosthetic valves. Most cases were associated with risk factors, including intravenous drug abuse (6 patients), infected intravenous lines (4 patients) or a recent invasive procedure (3 patients). The course of the disease appears to be indolent, but is otherwise similar to infective endocarditis associated with other gram-negative organisms. Antimicrobial therapy is complicated by multiple drug resistance of the organism; cotrimoxazole may be beneficial, if the isolate is susceptible, in combination with another agent. Five of nine (55%) patients who underwent valve replacement survived, as compared to three of seven (43%) who received antibiotic therapy only. Hence, surgery is not essential for survival in every case and depends as much on the individual patient's course as on established criteria for valve replacement in prosthetic valve endocarditis.
Insights
Stenotrophomonas maltophilia causes serious infections, often in patients with risk factors. While antibiotic therapy is challenging due to drug resistance, surgery may not always be essential for survival in prosthetic valve endocarditis.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Stenotrophomonas maltophilia, a gram-negative bacillus, is increasingly implicated in nosocomial infections.
- Infective endocarditis caused by S. maltophilia is rare, particularly prosthetic valve endocarditis.
Observation:
- A case of prosthetic valve endocarditis in a 69-year-old female patient caused by S. maltophilia is presented.
- Literature review identified 18 previous reports, with 10 involving prosthetic valves.
- Common risk factors include intravenous drug abuse, infected lines, and invasive procedures.
Findings:
- The disease course is typically indolent but mirrors endocarditis from other gram-negative organisms.
- Antimicrobial therapy is complicated by the organism's multidrug resistance; cotrimoxazole may be useful in combination.
- Survival rates were 55% with valve replacement versus 43% with antibiotics alone.
Implications:
- Surgical intervention is not universally required for survival in prosthetic valve endocarditis.
- Treatment decisions should consider individual patient factors and the organism's susceptibility profile.
- Further research into effective antimicrobial strategies for S. maltophilia endocarditis is warranted.