Department of Pharmacy, Birzeit University, Birzeit, Palestinian Territory, Occupied.
Department of Internal Medicine, Marshall University School of Medicine, Huntington, WV, USA.
Am J Case Rep. 2023 Jul 6;24:e939292. doi: 10.12659/AJCR.939292.
BACKGROUND We report 2 cases of recurrent right-sided endocarditis in 2 young patients known to be intravenous (i.v.) drug users. We highlight the importance of early diagnosis and management, especially in recurrent infection, which has a higher mortality rate and poor prognostic outcome despite antibiotic treatment. CASE REPORT A 30-year-old woman with a medical history of active i.v. drug use and tricuspid valve replacement owing to Serratia marcescens endocarditis 2 months prior to presentation was admitted to the Intensive Care Unit for septic shock. The patient did not respond to i.v. fluids and required vasopressors. Blood cultures returned positive for S. marcescens again. The antibiotic regimen consisted of meropenem and vancomycin. The patient underwent redo sternotomy, explant of old tricuspid valve bioprosthesis, debridement of tricuspid valve annulus, and bioprosthetic valve replacement. She continued antibiotic treatment during hospital admission for 6 weeks. In another similar case, a 30-year-old woman, also an i.v. drug user, was admitted to the hospital for tricuspid bioprosthetic valve S. marcescens endocarditis after tricuspid valve replacement 5 months prior to her presentation with S. marcescens endocarditis. Her antibiotic regimen consisted of meropenem and vancomycin. She was eventually transferred to a tertiary cardiovascular surgery center for further case management. CONCLUSIONS In the setting of recurrent bioprosthetic valve S. marcescens endocarditis, it is suggested that treatment should be more focused on source control, including cessation of i.v. drug abuse and providing appropriate antibiotic treatment to prevent recurrence because, in the case of recurrence, morbidity and mortality risk can increase significantly.
我们报告了 2 例年轻静脉（i.v.）药物使用者复发性右侧心内膜炎病例。我们强调了早期诊断和治疗的重要性，特别是在复发性感染中，尽管进行了抗生素治疗，但感染复发的死亡率和预后较差。
一名 30 岁女性，有静脉注射药物滥用史，2 个月前因产单核李斯特菌心内膜炎行三尖瓣置换术，因感染性休克入住重症监护病房。患者对静脉补液无反应，需要血管加压药。血培养再次检出产单核李斯特菌。抗生素方案包括美罗培南和万古霉素。患者行再次胸骨切开术，取出旧三尖瓣生物瓣，清创三尖瓣瓣环，更换生物瓣。她在住院期间继续接受 6 周的抗生素治疗。另一个类似病例，一名 30 岁女性，也是静脉药物使用者，在 5 个月前因产单核李斯特菌心内膜炎行三尖瓣生物瓣置换术后，因三尖瓣生物瓣产单核李斯特菌心内膜炎再次入院。她的抗生素方案包括美罗培南和万古霉素。最终她被转至三级心血管外科中心进一步治疗。
在复发性生物瓣产单核李斯特菌心内膜炎的情况下，建议更注重病因控制，包括停止静脉药物滥用和提供适当的抗生素治疗，以预防复发，因为在复发的情况下，发病率和死亡率风险会显著增加。
