title: Heart transplantation as salvage therapy for progressive prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis (MRSE).
abstract: BACKGROUND
  Prosthetic valve endocarditis (PVE) has the highest in-hospital mortality among all cases of infective endocarditis (IE), it is estimated at about 40 %. Orthotopic heart transplantation (OHT) as a measure of last resort, may be considered in selected cases where repeated surgical procedures and conservative efforts have failed to eradicate persistent or recurrent IE. Only few clinical data are available regarding this rare indication for OHT, since active IE has traditionally been considered as a contraindication for OHT.
  
  
  METHODS
  We report on a 55 year old male patient who underwent prosthetic valve replacement with a mechanical valved conduit ten years ago and developed now persistent PVE with severe complications due to methicillin-resistant Staphylococcus epidermidis (MRSE). Repeated surgical procedures and conservative efforts have failed to eradicate the pathogen. Regarding the lack of curative options, salvage OHT was discussed as a measure of last resort. 28 months after the first diagnosis of PVE, the patient was successfully transplanted and is now doing well under close follow-up (6 months post-OHT).
  
  
  CONCLUSIONS
  PVE remains a challenging condition regarding diagnosis and treatment. The presented case underscores the urgent need for an integrated and multidisciplinary approach to patients with suspected and definitive IE - especially in PVE. OHT might be a feasible measure of last resort in selected patients with IE. Our case report adds published clinical experience to this rarely performed procedure and consolidates previous findings.
authors.affiliation: Department of Internal Medicine, Ortenauklinikum Achern-Oberkirch, Division of Infectious Diseases, Josef-Wurzler-Straße 7, 77855, Achern, Germany. johannes.borde@web.de.|Department of Medicine, Division of Infectious Disease and Travel Medicine, Freiburg University Medical Center, Hugstetter Str. 55, 79106, Freiburg i.Br, Germany. johannes.borde@web.de.
authors.forename: J P
authors.initials: JP
authors.lastname: Borde
authors.affiliation: MVZ Clotten, Labor Dr. Haas, Dr. Raif & Kollegen, Merzhausener Straße 112a, 79100, Freiburg i.Br, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Sitaru
authors.affiliation: Eurotransplant International Foundation, P.O. Box 2304, 2301 CH, Leiden, The Netherlands.
authors.forename: W H
authors.initials: WH
authors.lastname: Kopp
authors.affiliation: Department of Cardiac Surgery, Heidelberg University Hospital Center, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Ruhparwar
authors.affiliation: Department of Cardiology, Heidelberg University Hospital Center, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Ehlermann
authors.affiliation: Institute of Pathology, Heidelberg University Hospital Center, Im Neuenheimer Feld 220/221, 69120, Heidelberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Lasitschka
authors.affiliation: Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital Center, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Dalpke
authors.affiliation: Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital Center, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Heininger
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006350:Heart Valve Prosthesis / Q000382:microbiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D016879:Salvage Therapy; D013203:Staphylococcal Infections / Q000382:microbiology*; D013212:Staphylococcus epidermidis / Q000302:isolation & purification*
keywords: Endocarditis; Heart transplantation; Methicillin-resistant Staphylococcus epidermidis (MRSE); Prosthetic heart valve endocarditis; Rifampicin resistance