- Email: [email protected]
Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance
International Journal of Cardiology 187 (2015) 678–679
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance P. Laganà ⁎, L. Melcarne, S. Delia Department of Biomedical Sciences and Images Morphological and Functional, University of Messina, Italy
a r t i c l e
i n f o
Article history: Received 1 April 2015 Accepted 2 April 2015 Available online 3 April 2015 Keywords: Infective endocarditis Acinetobacter baumannii Cardiac valve prosthesis Leak paravalvular
The incidence of infective endocarditis (IE) is 1.5–4.95 cases per 100,000 individuals per year, with a mortality of 14–46% one year after the infection [1–4]. Most of IE cases are caused by gram-positive cocci, including Staphylococci, Streptococci and Enterococci. Only a small number of cases are
due to gram-negative bacilli [5–7]. Acinetobacter baumannii is a gramnegative, non-motile coccobacillus. It is widely distributed in the environment. Its ability to survive even in hostile conditions allows it to a wide circulation in the hospital setting, where it is to date the most fearsome germ responsible for nosocomial infections. Risk factors for acquiring Acinetobacter infections include mechanical ventilation, especially in Intensive Care Unit or in prolonged hospital stays, surgical or other invasive procedures, use of broad spectrum antimicrobial treatment, use of dialysis machines, permanent central venous catheter, and presence of comorbidities such as immunosuppression and burns [8,9]. It can cause osteomyelitis, septic arthritis, periprosthetic infections, infections of the skin and soft tissue but there are not many cases of endocarditis [10,11]. We present our experience of two cases of lethal endocarditis on cardiac prostheses. The first patient was a female of 69 years who underwent to cardiac surgery for a chronic coronary syndrome. She was subjected to coronary artery bypass and to a substitution of the mitral valve with a biologic prosthesis and tricuspid annuloplasty. The entire procedure was long
Fig. 1. Panel A: Transthoracic echocardiography. Four chamber with mitral perivalvular leak. Panel B: Results of antimicrobial susceptibility testing for Acinetobacter baumannii, according to Clinical Laboratory Standards Institute and FDA guidelines.
⁎ Corresponding author at: Department of Biomedical Sciences and Images Morphological and Functional, University of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy. E-mail address: [email protected] (P. Laganà).
http://dx.doi.org/10.1016/j.ijcard.2015.04.019 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
P. Laganà et al. / International Journal of Cardiology 187 (2015) 678–679
but successful. The second patient was a male of 70 years who was subjected to a substitution of the mitral valve with a biologic prosthesis. Also in this case the procedure was successful. Both were discharged after a few days. One month after discharge they developed high fever and went to the emergency room. They quickly developed acute respiratory failure with clinical picture of septic shock and were transferred to the intensive care unit. Echocardiography showed perivalvular leak suggesting a complication of surgery (Fig. 1). In both cases they died in a few hours. The time of onset of symptoms correlates with the incubation period, also, the culture positive blood A. baumannii, in both patients, confirms the diagnosis. An autopsy was performed for both the patients. The final diagnosis was sudden cardiac death from infective endocarditis sustained by A. baumannii [12–15]. The relevance of this case is focused on the fact that IE sustained by the fearsome coccobacillus A. baumannii is not a frequent but always a possible cause of sudden death in patients undergoing cardiac surgery, especially for prosthesis implantation. Attention should be paid to the asepsis procedures of the operating room and of equipment. Conflict of interest
[3]
[4] [5]
[6]
[7]
[8]
[9]
[10]
The authors report no relationships that could be construed as a conflict of interest.
[11]
Acknowledgments
[12]
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
[13]
References [1] A. Luk, M.L. Kim, H.J. Ross, V. Rao, T.E. David, J. Butany, Native and prosthetic valve infective endocarditis: clinicopathologic correlation and review of the literature, Malays. J. Pathol. 36 (2) (2014) 71–81. [2] F. Delahaye, V.H. Chu, J. Altclas, B. Barsic, A. Delahaye, T. Freiberger, D.L. Gordon, M.M. Hannan, B. Hoen, S.S. Kanj, T. Lejko-Zupanc, C.A. Mestres, O. Pachirat, P. Pappas, C. Lamas, C. Selton-Suty, R. Tan, P. Tattevin, A. Wang, International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators,
[14]
[15]
679
One-year outcome following biological or mechanical valve replacement for infective endocarditis, Int. J. Cardiol. 178 (Jan 15 2015) 117–123. M. Mirabel, R. André, P. Barsoum, H. Colboc, F. Lacassin, B. Noel, O. Axler, G. Phelippeau, C. Braunstein, E. Marijon, B. Iung, X. Jouven, Ethnic disparities in the incidence of infective endocarditis in the Pacific, Int. J. Cardiol. 186 (Mar 18 2015) 43–44. I.M. Tleyjeh, A. Abdel-Latif, H. Rahbi, et al., A systematic review of population-based studies of infective endocarditis, Chest 132 (3) (2007) 1025–1035. E. Durante-Mangoni, R. Andini, F. Agrusta, D. Iossa, I. Mattucci, M. Bernardo, R. Utili, Infective endocarditis due to multidrug resistant gram-negative bacilli: single centre experience over 5 years, Eur. J. Intern. Med. 25 (2014) 657–661. D.R. Murdoch, G.R. Corey, B. Hoen, J.M. Miró, V.G. Fowler Jr., A.S. Bayer, et al., Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study, Arch. Intern. Med. 169 (2009) 463–473. S. Leone, V. Ravasio, E. Durante-Mangoni, et al., Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis, Infection 40 (2012) 527–535. N. Martins, I.S. Martins, W.V. de Freitas, J.A. de Matos, A.C.G. Magalhães, V.B.C. Girão, R.C.S. Dias, T.C. de Souza, F.L.P.C. Pellegrino, L.D. Costa, C.H.R. Boasquevisque, S.A. Nouér, L.W. Riley, G. Santoro-Lopes, B.M. Moreira, Severe infection in a lung transplant recipient caused by donor transmitted carbapenem-resistant Acinetobacter baumannii, Transpl. Infect. Dis. 14 (3) (June 2012) 316–320. C. Zhao, W. Xie, W. Zhang, Z. Ye, H. Wu, Mechanism of drug resistance of carbapenems-resistant Acinetobacter baumannii and the application of a combination of drugs in vitro, Zhonghua Shao Shang Za Zhi 30 (2) (Apr 2014) 166–170. M.E. Falagas, P. Kopterides, Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature, J. Hosp. Infect. 64 (2006) 7–15. R. Gaynes, J.R. Edwards, National Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli, Clin. Infect. Dis. 41 (2005) 848–854. I. Ikonomidis, G. Makavos, N. Nikitas, I. Paraskevaidis, A. Diamantakis, P. Kopterides, M. Theodorakopoulou, J. Parissis, J. Lekakis, A. Armaganidis, I. Dimopoulou, Coronary flow reserve is associated with tissue ischemia and is an additive predictor of intensive care unit mortality to traditional risk scores in septic shock, Int. J. Cardiol. 172 (1) (Mar 1 2014) 103–108. K. Sivakumar, J. Shahani, Transcatheter closure of paravalvular mitral prosthetic leak with resultant hemolysis, Int. J. Cardiol. 115 (1) (Jan 31 2007) e39–e40. E. Imbalzano, G. Di Bella, A. Lamari, M. Scarano, M. Casale, P. Busacca, S. Carerj, G. Dattilo, Right ventricular myocardial deformation in young healthy subjects: a comparison study between 2D strain and traditional parameters, J. Exp. Clin. Cardiol. 20 (1) (2014) 2729–2743. N.J. Mehta, I.A. Khan, V. Gupta, K. Jani, R.M. Gowda, P.R. Smith, Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock, Int. J. Cardiol. 95 (1) (May 2004) 13–17.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance P. Laganà ⁎, L. Melcarne, S. Delia Department of Biomedical Sciences and Images Morphological and Functional, University of Messina, Italy
a r t i c l e
i n f o
Article history: Received 1 April 2015 Accepted 2 April 2015 Available online 3 April 2015 Keywords: Infective endocarditis Acinetobacter baumannii Cardiac valve prosthesis Leak paravalvular
The incidence of infective endocarditis (IE) is 1.5–4.95 cases per 100,000 individuals per year, with a mortality of 14–46% one year after the infection [1–4]. Most of IE cases are caused by gram-positive cocci, including Staphylococci, Streptococci and Enterococci. Only a small number of cases are
due to gram-negative bacilli [5–7]. Acinetobacter baumannii is a gramnegative, non-motile coccobacillus. It is widely distributed in the environment. Its ability to survive even in hostile conditions allows it to a wide circulation in the hospital setting, where it is to date the most fearsome germ responsible for nosocomial infections. Risk factors for acquiring Acinetobacter infections include mechanical ventilation, especially in Intensive Care Unit or in prolonged hospital stays, surgical or other invasive procedures, use of broad spectrum antimicrobial treatment, use of dialysis machines, permanent central venous catheter, and presence of comorbidities such as immunosuppression and burns [8,9]. It can cause osteomyelitis, septic arthritis, periprosthetic infections, infections of the skin and soft tissue but there are not many cases of endocarditis [10,11]. We present our experience of two cases of lethal endocarditis on cardiac prostheses. The first patient was a female of 69 years who underwent to cardiac surgery for a chronic coronary syndrome. She was subjected to coronary artery bypass and to a substitution of the mitral valve with a biologic prosthesis and tricuspid annuloplasty. The entire procedure was long
Fig. 1. Panel A: Transthoracic echocardiography. Four chamber with mitral perivalvular leak. Panel B: Results of antimicrobial susceptibility testing for Acinetobacter baumannii, according to Clinical Laboratory Standards Institute and FDA guidelines.
⁎ Corresponding author at: Department of Biomedical Sciences and Images Morphological and Functional, University of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy. E-mail address: [email protected] (P. Laganà).
http://dx.doi.org/10.1016/j.ijcard.2015.04.019 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
P. Laganà et al. / International Journal of Cardiology 187 (2015) 678–679
but successful. The second patient was a male of 70 years who was subjected to a substitution of the mitral valve with a biologic prosthesis. Also in this case the procedure was successful. Both were discharged after a few days. One month after discharge they developed high fever and went to the emergency room. They quickly developed acute respiratory failure with clinical picture of septic shock and were transferred to the intensive care unit. Echocardiography showed perivalvular leak suggesting a complication of surgery (Fig. 1). In both cases they died in a few hours. The time of onset of symptoms correlates with the incubation period, also, the culture positive blood A. baumannii, in both patients, confirms the diagnosis. An autopsy was performed for both the patients. The final diagnosis was sudden cardiac death from infective endocarditis sustained by A. baumannii [12–15]. The relevance of this case is focused on the fact that IE sustained by the fearsome coccobacillus A. baumannii is not a frequent but always a possible cause of sudden death in patients undergoing cardiac surgery, especially for prosthesis implantation. Attention should be paid to the asepsis procedures of the operating room and of equipment. Conflict of interest
[3]
[4] [5]
[6]
[7]
[8]
[9]
[10]
The authors report no relationships that could be construed as a conflict of interest.
[11]
Acknowledgments
[12]
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
[13]
References [1] A. Luk, M.L. Kim, H.J. Ross, V. Rao, T.E. David, J. Butany, Native and prosthetic valve infective endocarditis: clinicopathologic correlation and review of the literature, Malays. J. Pathol. 36 (2) (2014) 71–81. [2] F. Delahaye, V.H. Chu, J. Altclas, B. Barsic, A. Delahaye, T. Freiberger, D.L. Gordon, M.M. Hannan, B. Hoen, S.S. Kanj, T. Lejko-Zupanc, C.A. Mestres, O. Pachirat, P. Pappas, C. Lamas, C. Selton-Suty, R. Tan, P. Tattevin, A. Wang, International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators,
[14]
[15]
679
One-year outcome following biological or mechanical valve replacement for infective endocarditis, Int. J. Cardiol. 178 (Jan 15 2015) 117–123. M. Mirabel, R. André, P. Barsoum, H. Colboc, F. Lacassin, B. Noel, O. Axler, G. Phelippeau, C. Braunstein, E. Marijon, B. Iung, X. Jouven, Ethnic disparities in the incidence of infective endocarditis in the Pacific, Int. J. Cardiol. 186 (Mar 18 2015) 43–44. I.M. Tleyjeh, A. Abdel-Latif, H. Rahbi, et al., A systematic review of population-based studies of infective endocarditis, Chest 132 (3) (2007) 1025–1035. E. Durante-Mangoni, R. Andini, F. Agrusta, D. Iossa, I. Mattucci, M. Bernardo, R. Utili, Infective endocarditis due to multidrug resistant gram-negative bacilli: single centre experience over 5 years, Eur. J. Intern. Med. 25 (2014) 657–661. D.R. Murdoch, G.R. Corey, B. Hoen, J.M. Miró, V.G. Fowler Jr., A.S. Bayer, et al., Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study, Arch. Intern. Med. 169 (2009) 463–473. S. Leone, V. Ravasio, E. Durante-Mangoni, et al., Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis, Infection 40 (2012) 527–535. N. Martins, I.S. Martins, W.V. de Freitas, J.A. de Matos, A.C.G. Magalhães, V.B.C. Girão, R.C.S. Dias, T.C. de Souza, F.L.P.C. Pellegrino, L.D. Costa, C.H.R. Boasquevisque, S.A. Nouér, L.W. Riley, G. Santoro-Lopes, B.M. Moreira, Severe infection in a lung transplant recipient caused by donor transmitted carbapenem-resistant Acinetobacter baumannii, Transpl. Infect. Dis. 14 (3) (June 2012) 316–320. C. Zhao, W. Xie, W. Zhang, Z. Ye, H. Wu, Mechanism of drug resistance of carbapenems-resistant Acinetobacter baumannii and the application of a combination of drugs in vitro, Zhonghua Shao Shang Za Zhi 30 (2) (Apr 2014) 166–170. M.E. Falagas, P. Kopterides, Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature, J. Hosp. Infect. 64 (2006) 7–15. R. Gaynes, J.R. Edwards, National Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli, Clin. Infect. Dis. 41 (2005) 848–854. I. Ikonomidis, G. Makavos, N. Nikitas, I. Paraskevaidis, A. Diamantakis, P. Kopterides, M. Theodorakopoulou, J. Parissis, J. Lekakis, A. Armaganidis, I. Dimopoulou, Coronary flow reserve is associated with tissue ischemia and is an additive predictor of intensive care unit mortality to traditional risk scores in septic shock, Int. J. Cardiol. 172 (1) (Mar 1 2014) 103–108. K. Sivakumar, J. Shahani, Transcatheter closure of paravalvular mitral prosthetic leak with resultant hemolysis, Int. J. Cardiol. 115 (1) (Jan 31 2007) e39–e40. E. Imbalzano, G. Di Bella, A. Lamari, M. Scarano, M. Casale, P. Busacca, S. Carerj, G. Dattilo, Right ventricular myocardial deformation in young healthy subjects: a comparison study between 2D strain and traditional parameters, J. Exp. Clin. Cardiol. 20 (1) (2014) 2729–2743. N.J. Mehta, I.A. Khan, V. Gupta, K. Jani, R.M. Gowda, P.R. Smith, Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock, Int. J. Cardiol. 95 (1) (May 2004) 13–17.