Marvelous but Morbid: Infective endocarditis due to Serratia marcescens.
Marvelous but Morbid: Infective endocarditis due to Serratia marcescens.
复制标题
DOI：
10.1097/ipc.0000000000000360
复制
发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Jacob JT
中科院分区：
文献类型：
--
作者：
Phadke VK;Jacob JT
一名46岁男子感染艾滋病毒和积极静脉吸毒提出了约两个星期的发烧和身体疼痛。体格检查时，他嗜睡，有新的收缩期杂音，双侧结膜水肿，弥漫性瘀点和左侧手臂无力。超声心动图显示一个大的二尖瓣赘生物和脑成像显示许多栓塞性梗死。血培养生长粘质沙雷氏菌。尽管使用美罗培南进行了积极治疗，但患者因颅内出血并发脑疝而死亡。粘质沙雷氏菌是一种罕见的感染性心内膜炎的原因。虽然这种疾病在历史上与静脉注射毒品有关，但最近的报告表明，它现在主要是慢性病患者机会性感染的结果。我们的病例突出了这种感染的几个特征，包括分离出一种无色素的微生物菌株，抗生素敏感性特征提示AmpC β-内酰胺酶的产生，以及临床快速恶化伴多种栓塞并发症导致死亡。在这篇综述中，我们讨论了沙雷氏菌属血管内感染的历史，流行病学和管理，强调在静脉吸毒者心内膜炎的鉴别诊断中考虑该微生物的持续重要性，并将其作为外科治疗的潜在指征。
A 46-year-old man with HIV infection and active intravenous drug use presented with approximately two weeks of fevers and body aches. On physical examination he was somnolent, had a new systolic murmur, bilateral conjunctival hemorrhages, diffuse petechiae, and left-sided arm weakness. Echocardiography revealed a large mitral valve vegetation and brain imaging demonstrated numerous embolic infarctions. Blood cultures grew Serratia marcescens. Despite aggressive treatment with meropenem the patient died due to intracranial hemorrhage complicated by herniation. Serratia marcescens is an uncommon cause of infective endocarditis. While this disease has historically been associated with intravenous drug use, more recent reports suggest that it is now largely a consequence of opportunistic infections of the chronically ill. Our case highlights several characteristic features of this infection, including isolation of a non-pigmented strain of the organism, an antibiotic susceptibility profile suggestive of AmpC β-lactamase production, and rapid clinical deterioration with multiple embolic complications resulting in death. In this review we discuss the history, epidemiology, and management of endovascular infections due to Serratia spp., emphasizing the continued importance of considering this organism in the differential diagnosis of endocarditis among intravenous drug users and as a potential indication for surgical therapy.