Acute Bivalvular Left-Sided Methicillin-Resistant Staphylococcus Aureus Endocarditis with Cardiac, Cerebral, Renal and Septic Complications

• Autor(a) principal: Póvoas, D
• Data de Publicação: 2011
• Outros Autores: Figueiredo, M, Murinello, A, Damásio, H, Ramos, A, Rodrigues, N, Sousa, J, Carvalho, F, Peres, H, Gomes, P
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/613
• topic: Doença Aguda; Lesão Renal Aguda; Válvula Aórtica; Bacteriemia; Endocardite Bacteriana; Resultado Fatal; Fungemia; Insuficiência Cardíaca; Estafilocócos Aureus Meticilino-Resistente; Infecções Relacionadas com Prótese; Infecções por Estafilocócos; Acidente Vascular Cerebral; AVC; HCC CAR; HCC MED; HCC NEF; HCC PAT CLIN

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.