title: Kocuria kristinae endocarditis related to diabetic foot infection.
abstract: We report an unusual case of endocarditis occurring in a 74-year-old man with a history of systemic hypertension, diabetes mellitus and minor amputation for left forefoot ulcer. The patient was hospitalized for vacuum-assisted closure therapy to aid in wound healing. After the first treatment session, the patient reported abdominal pain with haematemesis and fever (40 °C). Owing to persistent fever, three blood cultures were performed, all positive for Kocuria kristinae. The identification was based on biochemical tests and automated systems. The speciation of the micro-organism was achieved with MALDI-TOF and then confirmed by 16S rRNA gene sequencing. Transthoracic echocardiographic examination showed the presence of a large vegetation (38×20 mm) on the posterior mitral leaflet and moderate mitral regurgitation. Since there are no current guidelines for the treatment of K. kristinae endocarditis, empiric antibiotic therapy with intravenous sulbactam/ampicillin (1.5 g twice daily) and gentamicin (6 mg kg(-1) per day) was started. After 7 days of hospitalization, the patient's condition suddenly worsened because of the occurrence of haemorrhagic stroke. Despite inotropic support and rifampicin infusion, the haemodynamic status progressively deteriorated. After an initial improvement, he worsened again, becoming stuporous, hypotensive and dyspnoeic. In the following days, the patient developed compartment syndrome resulting in right foot ischaemia. Unfortunately, 25 days after hospitalization, the patient died of multiple organ failure from overwhelming sepsis. To the best of our knowledge, this is the first case of K. kristinae endocarditis on a native valve that is not related to a central venous catheter but associated with diabetic foot infection.
authors.affiliation: 'Heart' Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: 'Heart' Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Costantina
authors.initials: C
authors.lastname: Prota
authors.affiliation: U. O. C. 'Malattie Infettive', University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Greco
authors.affiliation: 'Heart' Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mirra
authors.affiliation: U. O. C. 'Malattie Infettive', University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Masullo
authors.affiliation: 'Heart' Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Silverio
authors.affiliation: 'Heart' Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: 'Heart' Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D048909:Diabetes Complications / Q000188:drug therapy / Q000382:microbiology*; D003920:Diabetes Mellitus; D017719:Diabetic Foot / Q000150:complications*; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008835:Micrococcaceae / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D008943:Mitral Valve / Q000382:microbiology; D054843:Negative-Pressure Wound Therapy
chemical_list: D000900:Anti-Bacterial Agents