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A Case of Infective Endocarditis Due to <i>Abiotrophia defectiva</i>, and Treatment with Ertapenem
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CASE REPORT
VOLUME: 10 ISSUE: 1
P: 10-10
January 2021

A Case of Infective Endocarditis Due to Abiotrophia defectiva, and Treatment with Ertapenem

Mediterr J Infect Microb Antimicrob 2021;10(1):10-10
DOI: 10.4274/mjima.galenos.2021.2020.10
Yücel DUMAN 1
Sibel ALTUNIŞIK TOPLU 2
Elif Seren TANRIVERDİ 1
Yaşar BAYINDIR 2
1. İnönü University Faculty of Medicine, Department of Medical Microbiology, Malatya, Turkey
2. İnönü University Faculty of Medicine, Department of Infectious Diseases and Medical Microbiology, Malatya, Turkey
No information available.
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Summary

The most frequently reported infections due to Abiotrophia defectiva worldwide are bacteraemia and endocarditis. It is estimated that A. defectiva causes approximately 5-6% of microbiologically proven endocarditis and plays a role in the etiology of culture negative endocarditis. In this article we reported a patient with infective endocarditis (IE) due to penicillin resistant A. defectiva, which caused vegetation in the mitral valve, embolism in the spleen and successfully treated with ertapenem. A 70-year-old female patient was admitted to the emergency service with fever and abdominal pain. The patient had a pronounced widespread abdominal tenderness in the left quadrant. The body temperature was 38.9 °C, C-reactive protein (CRP) level was 12.7 mg/dl and white blood cell count was 13.3x103 mm3. The patient was hospitalized to investigate fever’s reason. It was learned in the anamnesis that she used warfarin. Considering the pre-diagnosis of urinary tract infection, empirical treatment with ceftriaxone 2x1 g/day was started. However, due to the increase in International Normalized Ratio value on the second day of ceftriaxone treatment, ertapenem 1x1 g/day was started by considering drug interaction between warfarin and ceftriaxone. Transesophageal echocardiography of the patient revealed a 1.2x1.2 cm vegetation on the posterior leaflet surface of the mitral valve, and ischemia due to embolism in the spleen was detected on abdominal computer tomography. Penicillin resistant A. defectiva grew in the blood culture. The patient was diagnosed as having IE on the seventh day of her admission. Ertapenem treatment was completed in six weeks due to the patient’s absence of fever, decreased CRP level, and the absence of A. defectiva in the seventh day control blood culture. After treatment, vegetation was not observed in the transthoracic echocardiography of the patient and no signs of ischemia was detected in the spleen. Detection of A. defectiva shaped the follow-up process of our patient by bringing the diagnosis of IE to mind. In treatment of A. defectiva-related IE, guidelines suggest long-term combination of aminoglycosides with beta-lactams or vancomycin. However, in our patient, treatment was provided by using ertapenem alone for six weeks. In addition, we believed that early diagnosis and treatment in our patient prevented serious complications.

Keywords:
Abiotrophia defectiva, infective endocarditis, ertapenem

References

1
Frenkel A, Hirsch W. Spontaneous development of L forms of streptococci requiring secretions of other bacteria or sulphydryl compounds for normal growth. Nature. 1961;191:728-30.
2
Giannakopoulos K, Zompolou C, Behnes M, Elmas E, Borggrefe M, Akin I. Infective endocarditis - A word of caution on non-typical bacteria. Eur Rev Med Pharmacol Sci. 2016;20:4782-5.
3
Je H, Song D, Chan CL. Bacterial Endocarditis Caused by Abiotrophia defectiva in a Healthy Adult: A Case Report with Literature Review. Ann Clin Microbiol. 2019;22:23-7. Available from: https://synapse.koreamed. org/articles/1119063
4
Vahabi A, Gül F, Garakhanova S, Sipahi H, Sipahi OR. Pooled analysis of 1270 infective endocarditis cases in Turkey. J Infect Dev Ctries. 2019;13:93-100.
5
CLSI. Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. 3rd ed. CLSI guideline M45. Wayne, PA: Clinical and Laboratory Standards Institute; 2015. Available from: https://clsi.org/standards/products/microbiology/documents/m45/
6
Ramos JN, dos Santos LS, Vidal LM, Pereira PM, Salgado AA, Fortes CQ, Vieira VV, Mattos-Guaraldi AL, Júnior RH, Damasco PV. A case report and literature overview: Abiotrophia defectiva aortic valve endocarditis in developing countries. Infection. 2014;42:579-84.
7
Carleo MA, Del Giudice A, Viglietti R, Rosario P, Esposito V. Aortic Valve Endocarditis Caused by Abiotrophia defectiva: Case Report and Literature Overview. In Vivo. 2015;29:515-8.
8
Rudrappa M, Kokatnur L. Infective Endocarditis Due to Abiotrophia defectiva and Its Feared Complications in an Immunocompetent Person: Rare, But Real. J Glob Infect Dis. 2017;9:79-81.
9
Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O’Gara P, Taubert KA; American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132:1435-86.
10
Tuohy MJ, Procop GW, Washington JA. Antimicrobial susceptibility of Abiotrophia adiacens and Abiotrophia defectiva. Diagn Microbiol Infect Dis. 2000;38:189-91.
11
Stein DS, Nelson KE. Endocarditis due to nutritionally deficient streptococci: therapeutic dilemma. Rev Infect Dis. 1987;9:908-16.
12
Hashimoto T, Jodo S, Furusaki A, Kon Y, Amasaki Y, Atsumi T, Komatsu H, Shimokawa J, Yonezawa K, Koike T. A woman with infectious endocarditis caused by Abiotrophia defectiva. Intern Med. 2004;43:1000-4.
14
Lin CH, Hsu RB. Infective endocarditis caused by nutritionally variant streptococci. Am J Med Sci. 2007;334:235-9.
14
Gould FK, Denning DW, Elliott TS, Foweraker J, Perry JD, Prendergast BD, Sandoe JA, Spry MJ, Watkin RW, Working Party of the British Society for Antimicrobial Chemotherapy. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2012;67:269-89.
15
Sahar N, Czachor JS, Shahid M. Clearing the Dust-Off Abiotrophia defectiva. J Med Cases. 2019;10:277-9.