Miller Ethan, Jamal Hera, Patel Parita
Internal Medicine, Cooper Medical School of Rowan University, Camden, USA.
Internal Medicine, Cooper University Hospital, Camden, USA.
Cureus. 2024 Dec 25;16(12):e76368. doi: 10.7759/cureus.76368. eCollection 2024 Dec.
This case report presents a complex and challenging scenario of recurrent () bacteremia and tricuspid valve endocarditis in a 77-year-old male patient with multiple comorbidities and indwelling medical devices. The patient's medical history was significant for T4 paraplegia, neurogenic bladder requiring a chronic indwelling suprapubic catheter, heart block status post-permanent pacemaker placement, type 2 diabetes mellitus, chronic kidney disease, and chronic sacral wounds. The case highlights the difficulties in managing antibiotic-resistant infections, particularly in patients with implantable devices and chronic wounds. The patient's clinical course was marked by multiple hospital admissions, each time presenting with fever, confusion, and positive blood cultures for . Despite aggressive antibiotic treatment and interventions such as pacemaker replacement and tricuspid valve debulking, the patient's condition continued to deteriorate. The recurring nature of the infection, despite therapeutic interventions, underscores the risk of bacterial seeding of indwelling medical devices and the challenges posed by antibiotic resistance. This case also draws attention to the significance of as a causative agent of severe nosocomial infections, particularly in immunocompromised individuals, and its growing resistance to antibiotics through mechanisms such as biofilm formation. Ultimately, the patient developed septic shock and transitioned to comfort care due to treatment failure, highlighting the difficult clinical decisions required in the face of chronic infections refractory to repeated interventions. This case serves as a reminder of the need for continued vigilance and innovative strategies, such as multifunctional antibacterial-coated devices, in preventing and managing device-associated infections. This is particularly important in the context of increasing antibiotic resistance and the complications associated with biofilm formation.
本病例报告呈现了一名77岁男性患者的复杂且具有挑战性的复发性（）菌血症和三尖瓣心内膜炎情况，该患者患有多种合并症且体内有留置医疗设备。患者的病史包括T4截瘫、因神经源性膀胱需要长期留置耻骨上导尿管、永久性起搏器植入术后心脏传导阻滞、2型糖尿病、慢性肾脏病以及慢性骶部伤口。该病例凸显了管理耐抗生素（）感染的困难，尤其是在有植入设备和慢性伤口的患者中。患者的临床病程以多次住院为特征，每次均表现为发热、意识模糊以及血培养（）阳性。尽管进行了积极的抗生素治疗以及诸如更换起搏器和三尖瓣减容等干预措施，但患者的病情仍持续恶化。尽管进行了治疗干预，但感染的反复发生凸显了留置医疗设备细菌定植的风险以及抗生素耐药性带来的挑战。该病例还提请注意（）作为严重医院感染病原体的重要性，尤其是在免疫功能低下的个体中，以及其通过生物膜形成等机制对抗生素的耐药性不断增加。最终，患者因治疗失败发展为感染性休克并转为舒适护理，凸显了面对反复干预仍难以治愈的慢性感染时所需做出的艰难临床决策。该病例提醒人们需要持续保持警惕并采用创新策略，如多功能抗菌涂层设备，以预防和管理与设备相关的感染。在抗生素耐药性增加以及生物膜形成相关并发症的背景下，这一点尤为重要。
