Department of Internal Medicine. Centro Hospitalar Universitário de São João. Porto. Portugal.
Department of Infectious Diseases. Centro Hospitalar Universitário de São João. Porto. Portugal.
Acta Med Port. 2022 Dec 2;35(12):908-912. doi: 10.20344/amp.16377. Epub 2022 May 30.
Serratia marcescens is a rarely implicated agent in endocarditis. We describe a case of a patient that underwent aortic and mitral valve replacement for Streptococcus agalactiae endocarditis. Four months later, he was readmitted with an ischemic stroke and fever. Physical examination and repetitive transthoracic echocardiogram were unremarkable. The initial blood cultures were negative. Due to sustained fever, vancomycin, gentamicin and piperacillin-tazobactam were initiated. On subsequent blood cultures, Serratia marcescens was isolated and antibiotics switched to ertapenem and gentamicin. In addition to cerebral emboli, a splenic embolus was found. The PET/CT revealed an abnormal hypercaptation in the mitral bioprosthesis. The patient was treated for six weeks. There are no current specific recommendations regarding the treatment of Serratia marcescens endocarditis. It is widely accepted that treatment should be prolonged and include a combination of antimicrobial agents. Morbidity and mortality are high, particularly when there's the need for surgical replacement. In this case, however, the patient ended-up only requiring medical treatment due to the favourable response.
粘质沙雷氏菌是一种很少引起心内膜炎的病原体。我们描述了 1 例因无乳链球菌心内膜炎而行主动脉瓣和二尖瓣置换术的患者。4 个月后，他因缺血性脑卒中伴发热再次入院。体格检查和重复经胸超声心动图均无明显异常。初始血培养阴性。由于持续发热，给予万古霉素、庆大霉素和哌拉西林他唑巴坦。随后的血培养中分离出粘质沙雷氏菌，将抗生素更换为厄他培南和庆大霉素。除了脑栓塞外，还发现了脾栓塞。PET/CT 显示二尖瓣生物瓣有异常高摄取。患者接受了 6 周的治疗。目前对于粘质沙雷氏菌心内膜炎的治疗尚无具体建议。广泛接受的治疗方法是延长疗程并联合使用抗菌药物。发病率和死亡率都很高，特别是需要手术置换时。然而，在这种情况下，由于治疗反应良好，患者最终仅需要药物治疗。
