Andrijašević Nataša, Perešin Vranjković Martina, Dobrović Karolina, Pristaš Irina, Andrašević Saša, Tambić Andrašević Arjana
University Hospital for Infectious Disease Fran Mihaljevic, Mirogojska 8, 10000 Zagreb, Croatia.
University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia.
Infect Dis Rep. 2023 Jun 12;15(3):327-338. doi: 10.3390/idr15030033.
Right-sided infective endocarditis due to methicillin-resistant (MRSA) is strongly associated with intravenous drug abuse, congenital heart disease, or previous medical treatment and is rare in healthy patients without a history of drug abuse. Here, we present a case of an 18-year-old male with no drug abuse history and no medical burden who was diagnosed with MRSA tricuspid valve endocarditis. Due to initial symptoms which indicated community-acquired pneumonia and radiological finding of interstitial lesions, empiric therapy with ceftriaxone and azithromycin was started. After the detection of Gram-positive cocci in clusters in several blood culture sets, endocarditis was suspected, and flucloxacillin was added to the initial therapy. As soon as methicillin resistance was detected, the treatment was switched to vancomycin. Transesophageal echocardiography established the diagnosis of right-sided infective endocarditis. A toxicological analysis of hair was carried out, and no presence of narcotic drugs was found. After six weeks of therapy, the patient was fully recovered. Exceptionally, tricuspid valve endocarditis can be diagnosed in previously healthy people who are not drug addicts. As the clinical presentation commonly resembles a respiratory infection, a misdiagnosis is possible. Although MRSA rarely causes community-acquired infections in Europe, clinicians should be aware of this possibility.
耐甲氧西林金黄色葡萄球菌（MRSA）所致右侧感染性心内膜炎与静脉药物滥用、先天性心脏病或既往医疗治疗密切相关，在无药物滥用史的健康患者中较为罕见。在此，我们报告一例18岁男性患者，无药物滥用史且无基础疾病，被诊断为MRSA三尖瓣心内膜炎。由于初始症状提示社区获得性肺炎且影像学检查发现间质性病变，开始使用头孢曲松和阿奇霉素进行经验性治疗。在多次血培养中检测到成簇的革兰氏阳性球菌后，怀疑为心内膜炎，遂在初始治疗中加用氟氯西林。一旦检测到耐甲氧西林，治疗改为万古霉素。经食管超声心动图确诊为右侧感染性心内膜炎。进行了毛发毒理学分析，未发现麻醉药品。经过六周治疗，患者完全康复。罕见的是，非吸毒成瘾的既往健康人群也可诊断为三尖瓣心内膜炎。由于临床表现通常类似呼吸道感染，可能会出现误诊。尽管在欧洲MRSA很少引起社区获得性感染，但临床医生应意识到这种可能性。
