Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Dec 15, 2019; 9(3): 23-30
Published online Dec 15, 2019. doi: 10.5495/wjcid.v9.i3.23
Serratia marcescens and other non-AACEK GNB endocarditis: A case report and review of literature
Helena Mertes, Marielle Morissens, Bhavna Mahadeb, Evelyne Maillart, Anthony Moreau, Philippe Clevenbergh
Helena Mertes, Infectious Disease Department, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerpen 2020, Belgium
Marielle Morissens, Cardiology Department, Brugmann University Hospital, Brussels 1020, Belgium
Bhavna Mahadeb, Microbiology Department, Brugmann University Hospital, Brussels 1020, Belgium
Evelyne Maillart, Philippe Clevenbergh, Infectious Diseases Department, Brugmann University Hospital, Brussels 1020, Belgium
Anthony Moreau, Intensive Care Unit, Erasmus University Hospital, Intensive Care Unit, Brussels 1070, Belgium
Author contributions: All authors equally contributed to this paper with regards to the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors report no conflicts of interest.
CARE Checklist (2016) statement: The guidelines of the "CARE Checklist - 2016: Information for writing a case report" have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Helena Mertes, MD, Doctor, Infectious Disease Department, Ziekenhuis Netwerk Antwerpen Middelheim, Lindendreef 1, Antwerpen 2020, Belgium. hellibi@hotmail.com
Telephone: +32-3-2803860
Received: May 23, 2019
Peer-review started: May 23, 2019
First decision: August 7, 2019
Revised: September 3, 2019
Accepted: November 26, 2019
Article in press: November 26, 2019
Published online: December 15, 2019
Abstract
BACKGROUND

Non-Aggregatibacter aphrophilus, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp. (non-AACEK) gram-negative bacilli (GNBs) are an infrequent and challenging cause of endocarditis associated previously with mainly intravenous drug use. Currently, this pathology has increasingly become a healthcare-associated issue. Current guidelines do not clearly define the management of non-AACEK GNB endocarditis due to a lack of prospective trials. We review characteristics, outcomes and treatment of non-AACEK GNB endocarditis, in particular Serratia marcescens endocarditis.

CASE SUMMARY

We describe the case report of a 46-year-old man who presented to the emergency department with high-grade fever and a purulent exudate on an intracardiac device site. Serratia marcescens mitral valve endocarditis as a consequence of complicated generator pocket infection was diagnosed. The patient was treated with complete device removal and a long course of broad-spectrum antibiotics for 6 wk after surgery with intravenous piperacillin-tazobactam and ciprofloxacin, which was later switched to oral ciprofloxacin and sulfamethoxazole-trimethoprim. The patient had complete resolution of symptoms and inflammatory parameters at the end of the treatment and at follow-up.

CONCLUSION

Long-term dual-antibiotic therapy containing a beta-lactam is indicated for most non-AACEK GNB endocarditis, whereas valve surgery may not be necessary in all patients.

Keywords: Non-AACEK gram-negative bacilli endocarditis, Serratia marcescens, Healthcare-associated, Intravenous drug use, Case report, Dual-antibiotic therapy

Core tip: While gram-negative bacillus (GNB) Non-Aggregatibacter aphrophilus, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp. (non-AACEK) endocarditis has been associated with mainly intravenous drug use, the role of healthcare-associated contact has been highlighted in two prospective observational studies. Our aim was to review the characteristics and management of non-AACEK GNB endocarditis, especially in the case of Serratia marcescens. This bacterium has become a rare cause of endocarditis, but community acquisition still has an important role in this disease. We discuss treatment options, supporting long-term dual-antibiotic treatment as the preferred option for most patients with non-AACEK GNB endocarditis, whereas valve surgery does not seem to be necessary in all patients.