Nosocomial infective endocarditis in a renal transplant patient: culprit central venous line
Keywords:
Central venous catheter, Infective endocarditis, Vegetation, Solid organ transplant (SOT)Abstract
Nosocomial infective endocarditis (IE) is a relatively uncommon but, a serious complication affecting critically ill hospitalized patients who are frequently exposed to life-saving invasive procedures. Immunosuppressive treatment in solid organ transplant recipients predisposes to infections, nevertheless, nonspecific symptoms of IE, such as fever, lassitude, weight loss, and signs of inflammation may often be misinterpreted as acute rejection episode or a common urinary tract infection. The case reported here was a recent renal transplant with methicillin-resistant Staphylococcus aureus IE. We believe the diagnoses of IE in her were missed at her first presentation due to her non-specific symptoms and lack of echocardiography and blood culture results. Septic procedure at insertion of central venous catheter (CVC) in the Intensive Care Unit with trauma to tricuspid valve (TV) at the time of CVC insertion was a possible source of infection for IE. The patient was managed effectively with intravenous antibiotics in spite of having hanging pedunculated vegetation on TV.
References
Yankah AC, Klose H, Petzina R, Musci M, Siniawski H, Hetzer R. Surgical management of acute aortic root endocarditis with viable homograft: 13-year experience. Eur J Cardiothorac Surg. 2002;21(2):260-7.
Kalra PR, Tang AT, Morgan JM, Haw MP. Complex and extensive infective endocarditis: a novel surgical approach. Eur J Cardiothorac Surg. 2002;21(2):
Aoyagi S, Fukunaga S, Tayama E, Hayashida N, Kawara T. Surgical treatment of prosthetic valve endocarditis with left ventricular-aortic discontinuity: reconstruction of the left ventricular outflow tract with a xenopericardial conduit. J Heart Valve Dis 2001;10(3):367-70.
Shapiro SM, Young E, De Guzman S, Ward J, Chiu CY, Ginzton LE, et al. Transesophageal echocardiography in diagnosis of infective endocarditis. Chest. 1994;105(2):377-82.
Von Reyn CF, Levy BS, Arbeit RD, Friedland G, Crumpacker CS. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med. 1981;94:505-18.
Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994;96(3):200-9.
Ruttmann E, Bonatti H, Legit C, Ulmer H, Stelzmueller I, Antretter H, et al. Severe endocarditis in transplant recipients--an epidemiologic study. Transpl Int. 2005;18(6):690-6.
Hurr H, Hawley HB, Czachor JS, Markert RJ, McCarthy MC. APACHE II and ISS scores as predictors of nosocomial infections in trauma patients. Am J Infect Control. 1999;27(2):79-83.
Karth G, Koreny M, Binder T, Knapp S, Zauner C, Valentin A, et al. Complicated infective endocarditis necessitating ICU admission: clinical course and prognosis. Crit Care. 2002;6(2):149-54.
Roberts WC, Buchbinder NA. Right-sided valve endocarditis: a clinopathological study of twelve necropsy patients. Am J Med, 1972;53:7-193.
Nandakumar R, Raju G. Isolated tricuspid valve endocarditis in nonaddicted patients: a diagnostic challenge. Am J Med Sci. 1997;314(3):207-12.
Andrews RT, Geschwind JF, Savader SJ, Venbrux AC. Entrapment of J-tip guidewires by Venatech and stainless-steel Greenfield vena cava filters during central venous catheter placement: percutaneous management in four patients. Cardiovasc Intervent Radiol. 1998;21(5):424-8.
Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001;345(18):1318-30.
Fletcher SJ, Bodenham AR. Safe placement of central venous catheters: where should the tip of the catheter lie? Br J Anaesth. 2000;85(2):188-91.
Chrissoheris MP, Libertin C, Ali RG, Ghantous A, Bekui A, Donohue T. Endocarditis complicating central venous catheter bloodstream infections: a unique form of health care associated endocarditis. Clin Cardiol. 2009;32(12):E48-54.
Kale SB, Raghavan J. Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection. Indian J Anaesth. 2013;57(4):390-3.
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009;30(19):2369-413.
Steckelberg JM, Murphy JG, Ballard D, Bailey K, Tajik AJ, Taliercio CP, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med. 1991;114(8):635-40.
Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation. 2005;112(1):69-75.