title: Infective endocarditis due to multidrug resistant gram-negative bacilli: single centre experience over 5 years.
abstract: BACKGROUND
  Infective endocarditis (IE) due to gram-negative (GN) bacilli is uncommon. Although multi- and extensively-drug resistant (MDR/XDR) GN infections are emerging, very few data are available on IE due to these microrganisms.
  
  
  METHODS
  In this study, we describe the clinical characteristics, course and outcome of five contemporary, definite, MDR/XDR GNIE cases seen at our centre.
  
  
  RESULTS
  All patients had been admitted to a hospital during the 6months before IE onset, 2 were on hemodialysis and 3 on intravenous medications. Three of the 5 cases were hospital-acquired. Intracardiac prosthetic devices were present in all cases (3 central venous lines, 2 prosthetic heart valves, 2 pacemakers). Mean Charlson comorbidity index was 5.8. Causative pathogens were XDR Pseudomonas aeruginosa (2 cases), XDR Acinetobacter baumannii, MDR Burkolderia cepacia and MDR Escherichia coli (1 case each). Concomitant pathogens with a MDR/XDR phenotype were isolated in 4 patients. Both valves and intracardiac devices and left and right sides of the heart were involved. The rate of complications was high. Antibiotic treatment hinged on the use of colistin, a carbapenem or both. Cardiovascular surgical procedures were performed in 3 patients. Despite aggressive therapeutic regimens, outcomes were poor. Clearance of bacteremia was obtained in 3 patients, in-hospital death occurred in 3 patients, only 1 patient survived during follow up.
  
  
  CONCLUSIONS
  MDR/XDR GN are emerging as a cause of IE in carriers of intracardiac prostheses with extensive healthcare contacts and multiple comorbidities. Resistant GNIE has a complicated course and shows a dismal prognosis.
authors: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Naples, Italy. Electronic address: emanuele.durante@unina2.it.
authors: Emanuele
authors: E
authors: Durante-Mangoni
authors: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Naples, Italy.
authors: Roberto
authors: R
authors: Andini
authors: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Naples, Italy.
authors: Federica
authors: F
authors: Agrusta
authors: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Naples, Italy.
authors: Domenico
authors: D
authors: Iossa
authors: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Naples, Italy.
authors: Irene
authors: I
authors: Mattucci
authors: Microbiology and Virology Unit, Monaldi Hospital, Naples, Italy.
authors: Mariano
authors: M
authors: Bernardo
authors: Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N., Monaldi Hospital, Naples, Italy.
authors: Riccardo
authors: R
authors: Utili
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Anti-infective agents; Colistin; Heart valve prostheses; Nosocomial Infection; Prosthesis-related infections