![]() ![]() After 1 week of antibiotic therapy, surveillance blood cultured was negative and after 2 weeks, TEE showed a reduction of the vegetation. The fundoscopic examination and formal ophthalmology evaluation showed a posterior pole ischemic edema of the retina to be reported to a supratemporal branch retinal artery occlusion due to embolic event. During the first week of hospitalization, the patient reported a sudden visus reduction. The patient was treated with intravenous ceftazidime 2 g × 2/day and gentamicin 160 mg/day according to renal function. The surgeon did not pose a clear indication for valvular replacement but a “wait and see” indication and a revaluation by TEE after 2 weeks of antibiotic therapy. The patient fulfilled the Duke clinical criteria for definite endocarditis based on the trans-esophageal echocardiographic findings and positive blood culture (two major criteria). After a questionable transthoracic cardiac ultrasound, the suspicion of endocarditis persisted and the patient underwent trans-esophageal echocardiogram (TEE) which revealed a mobile mass measuring 12 mm attached to the anterior leaflet of the mitral valve and a moderate regurgitation. Two blood culture sets and urine sample were drawn, and an empiric therapy with ciprofloxacin iv 400 bid was started.ĮSBL-negative Proteus mirabilis, resistant to ciprofloxacin and trimethoprim/sulfamethoxazole, was cultured both from blood (Table 2) and urinary culture samples. Renal ultrasound showed bilateral non-obstructive kidney stones with no urologic indication to extraction or dissolution. The urine sediment showed 500 white blood cells and bacteria on microscopy examination. Sequential Organ Failure Assessment (SOFA) Score was 3 points. Laboratory investigation revealed the following measurements: white blood cell count 14.2 × 10 3 cells/μL with 90% neutrophils, creatinine 2.57 mg/dL (0.40–1.10 mg/dL), and C-reactive protein (CRP) 13.22 mg/dL (0.00–0.75 mg/dL). Cardiac examination was negative and the lungs were clear to auscultation. No focal neurological signs were present. At the time of admission, the patient’s temperature was 39 ☌, the blood pressure was 90/60 mmHg, and the heart rate was 94 beats per minute. We describe a case of native valve endocarditis due to Proteus mirabilis, successfully treated with antibiotic therapy alone and a literature review on this topic (through 1 November 2020).Ī 86-year-old female with a history of aorta arch replacement in 2015 and atrial fibrillation in medical treatment was admitted to our Hospital with fever, urinary burning, and altered mental status. Although a systematic review was recently published, our aim was to compare data, investigate clinical characteristics of patients and risk factors, type of treatment, duration of therapy with a focus on native valve endocarditis. The best antibiotic treatment for these patients is currently unknown guidelines from the AHA and ESC recommend prolonged courses of combined antibiotic therapy but information regarding the clinical presentation, the choice of treatment, the surgical management, and the duration of therapy can only be taken from clinical cases reported in literature. Proteus mirabilis is one such pathogen that frequently appears in the bloodstream during urinary tract infection but rarely results in endocarditis. The most common organisms implicated are Staphylococci, Streptococci, and Enterococci Gram-negative agents are rarely implicated. ![]() ![]() ![]() The usual treatment involves a prolonged course of antibiotics with up to 40–50% of patients needing valve replacement during initial hospital admission. If left untreated, it can have adverse consequences including elevated mortality. Infective endocarditis (IE) is a life-threatening condition. ![]()
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