title: Acute bivalvular left-sided methicillin-resistant Staphylococcus aureus endocarditis with cardiac, cerebral, renal and septic complications.
abstract: Infective endocarditis (IE) is now rare in developed countries, but its prevalence is higher in elderly patients with prosthetic valves, diabetes, renal impairment, or heart failure. An increase in health-care associated IE (HCAIE) has been observed due to invasive maneuvers (30% of cases). Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus are the most common agents in HCAIE, causing high mortality and morbidity. We review complications of IE and its therapy, based on a patient with acute bivalvular left-sided MRSA IE and a prosthetic aortic valve, aggravated by congestive heart failure, stroke, acute immune complex glomerulonephritis, Candida parapsilosis fungémia and death probably due to Serratia marcescens sepsis. The HCAIE was assumed to be related to three temporally associated in-hospital interventions considered as possible initial etiological mechanisms: overcrowding in the hospital environment, iv quinolone therapy and red blood cell transfusion. Later in the clinical course, C. parapsilosis and S. marcescens septicemia were considered to be possible secondary etiological mechanisms of HCAIE.
authors.affiliation: Unit of Internal Medicine, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: Diana
authors.initials: D
authors.lastname: Póvoas
authors.forename: Manuel
authors.initials: M
authors.lastname: de Figueiredo
authors.forename: António
authors.initials: A
authors.lastname: Murinello
authors.forename: Helena
authors.initials: H
authors.lastname: Damásio
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ramos
authors.forename: Nuno
authors.initials: N
authors.lastname: Rodrigues
authors.forename: João
authors.initials: J
authors.lastname: Sousa
authors.forename: Fernanda
authors.initials: F
authors.lastname: Carvalho
authors.forename: Helena
authors.initials: H
authors.lastname: Peres
authors.forename: Patrícia
authors.initials: P
authors.lastname: Gomes
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000150:complications; D000369:Aged, 80 and over; D001021:Aortic Valve; D016470:Bacteremia / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D016469:Fungemia / Q000382:microbiology; D006333:Heart Failure / Q000150:complications; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D016459:Prosthesis-Related Infections / Q000150:complications*; D013203:Staphylococcal Infections / Q000150:complications* / Q000209:etiology; D020521:Stroke / Q000150:complications