Endocarditis infecciosa izquierda por Pseudomonas aeruginosa tratada médicamente

Karen Melissa Ordóñez, Odismar Andrea Hernández, Jorge Alberto Cortés, María José López, Gladys Alfonso, Alejandro Junca, .

Palabras clave: endocarditis, Pseudomonas aeruginosa, válvula aórtica, embolia, terapia combinada, mortalidad

Resumen

La endocarditis infecciosa por Pseudomonas aeruginosa es una entidad poco frecuente, de difícil diagnóstico y alta mortalidad. Se presenta a continuación el caso de un hombre de 51 años, sin antecedentes de uso de drogas intravenosas ni enfermedad valvular, con antecedentes de colecistectomía en el mes anterior, quien se presentó a urgencias con un cuadro febril asociado a síntomas gastrointestinales, y, posteriormente mostró signos de embolismo a distancia, hemocultivos positivos para P. aeruginosa y desarrollo de múltiples complicaciones propias de la enfermedad.
La presentación clínica de la endocarditis infecciosa es inespecífica, lo cual genera diagnósticos tardíos que impiden la instauración de un tratamiento precoz y eficaz, como el reemplazo valvular, indicado en endocarditis por hongos o por gérmenes como P. aeruginosa. Este caso es fortuito por su resolución solamente con tratamiento médico combinado, con amikacina y meropenem, ya que tuvo varias complicaciones que contraindicaron el manejo quirúrgico.

Descargas

La descarga de datos todavía no está disponible.
  • Karen Melissa Ordóñez Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • Odismar Andrea Hernández Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • Jorge Alberto Cortés Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • María José López Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • Gladys Alfonso Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • Alejandro Junca Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia

Referencias bibliográficas

1. Reisberg B. Infective endocarditis in the narcotic addict. Prog Cardiovasc Dis. 1979;22:193-204.
2. Wieland M, Lederman MM, Kline-King C, Kevs TF, Lerner PI, Bass SN, et al. Left-sided endocarditis due to Pseudomonas aeruginosa. A report of 10 cases and review of the literature. Medicine (Baltimore). 1986;65:180-9.
3. Reyes MP, Palutke WA, Wylin RF, Lerner AM. Pseudomonas endocarditis in the Detroit Medical Centre 1969-72. Medicine. 1973;52:173-94.
4. Witchitz S, Gilbert C, Witchitz J, Gougerot M, Vachon F, Vic-Dupont V. Pseudomonas aeruginosa endocarditis. A report of nine cases. Eur J Cardiol. 1976;4:91-7.
5. Finkelstein R, Boulus M, Markievicz M. Hospital-acquired Pseudomonas aeruginosa endocarditis. J Hosp Infect. 1991;18:161-3.
6. Berlin JA, Abrutyn E, Strom BL, Kinman JL, Levison ME, Korseniowski OM, et al. Incidence of infective endocarditis in the Delaware Valley 1988-1990. Am J Cardiol. 1995; 76:933-6.
7. Durack DT. Infective endocarditis. Infect Dis Clin N Am. 2002;16:xv-xix.
8. von Reyn CF, Levy BS, Arbeit RD, Friedland G, Crumpacker CS. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med. 1981; 94:505-18.
9. Bayer AS, Ward JI, Ginzton LE, Shapiro SM. Evaluation of new clinical criteria for the diagnosis of infective endocarditis. Am J Med. 1994;96:211-9.
10. Pelletier LL, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963-72. Medicine. 1977;56:287-313.
11. Sachdev M, Peterson G, Jollis J. Imaging techniques for diagnosis of infective endocarditis. Infect Dis Clin N Am. 2002:16:319-37.
12. Chirillo F, Bruni A, Giujusa T, Totis O, Cavarzerani A, Stritoni P. Echocardiography in infective endocarditis: reassesment of the diagnostic criteria of vegetation as evaluated from the precordial and transesophageal approach. Am J Card Imaging. 1995;9:174-9.
13. Morguet AJ, Werner GS, Andreas S, Kreuzer H. Diagnostic value of transesophageal compared with 1. Reisberg B. Infective endocarditis in the narcotic addict. Prog Cardiovasc Dis. 1979;22:193-204.
2. Wieland M, Lederman MM, Kline-King C, Kevs TF, Lerner PI, Bass SN, et al. Left-sided endocarditis due to Pseudomonas aeruginosa. A report of 10 cases and review of the literature. Medicine (Baltimore). 1986;65:180-9.
3. Reyes MP, Palutke WA, Wylin RF, Lerner AM. Pseudomonas endocarditis in the Detroit Medical Centre 1969-72. Medicine. 1973;52:173-94.
4. Witchitz S, Gilbert C, Witchitz J, Gougerot M, Vachon F, Vic-Dupont V. Pseudomonas aeruginosa endocarditis. A report of nine cases. Eur J Cardiol. 1976;4:91-7.
5. Finkelstein R, Boulus M, Markievicz M. Hospital-acquired Pseudomonas aeruginosa endocarditis. J Hosp Infect. 1991;18:161-3.
6. Berlin JA, Abrutyn E, Strom BL, Kinman JL, Levison ME, Korseniowski OM, et al. Incidence of infective endocarditis in the Delaware Valley 1988-1990. Am J Cardiol. 1995; 76:933-6.
7. Durack DT. Infective endocarditis. Infect Dis Clin N Am. 2002;16:xv-xix.
8. von Reyn CF, Levy BS, Arbeit RD, Friedland G, Crumpacker CS. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med. 1981; 94:505-18.
9. Bayer AS, Ward JI, Ginzton LE, Shapiro SM. Evaluation of new clinical criteria for the diagnosis of infective endocarditis. Am J Med. 1994;96:211-9.
10. Pelletier LL, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963-72. Medicine. 1977;56:287-313.
11. Sachdev M, Peterson G, Jollis J. Imaging techniques for diagnosis of infective endocarditis. Infect Dis Clin N Am. 2002:16:319-37.
12. Chirillo F, Bruni A, Giujusa T, Totis O, Cavarzerani A, Stritoni P. Echocardiography in infective endocarditis: reassesment of the diagnostic criteria of vegetation as evaluated from the precordial and transesophageal approach. Am J Card Imaging. 1995;9:174-9.
13. Morguet AJ, Werner GS, Andreas S, Kreuzer H. Diagnostic value of transesophageal compared with 1. Reisberg B. Infective endocarditis in the narcotic addict. Prog Cardiovasc Dis. 1979;22:193-204.
2. Wieland M, Lederman MM, Kline-King C, Kevs TF, Lerner PI, Bass SN, et al. Left-sided endocarditis due to Pseudomonas aeruginosa. A report of 10 cases and review of the literature. Medicine (Baltimore). 1986;65:180-9.
3. Reyes MP, Palutke WA, Wylin RF, Lerner AM. Pseudomonas endocarditis in the Detroit Medical Centre 1969-72. Medicine. 1973;52:173-94.
4. Witchitz S, Gilbert C, Witchitz J, Gougerot M, Vachon F, Vic-Dupont V. Pseudomonas aeruginosa endocarditis. A report of nine cases. Eur J Cardiol. 1976;4:91-7.
5. Finkelstein R, Boulus M, Markievicz M. Hospital-acquired Pseudomonas aeruginosa endocarditis. J Hosp Infect. 1991;18:161-3.
6. Berlin JA, Abrutyn E, Strom BL, Kinman JL, Levison ME, Korseniowski OM, et al. Incidence of infective endocarditis in the Delaware Valley 1988-1990. Am J Cardiol. 1995; 76:933-6.
7. Durack DT. Infective endocarditis. Infect Dis Clin N Am. 2002;16:xv-xix.
8. von Reyn CF, Levy BS, Arbeit RD, Friedland G, Crumpacker CS. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med. 1981; 94:505-18.
9. Bayer AS, Ward JI, Ginzton LE, Shapiro SM. Evaluation of new clinical criteria for the diagnosis of infective endocarditis. Am J Med. 1994;96:211-9.
10. Pelletier LL, Petersdorf RG. Infective endocarditis: a review of 125 cases from the University of Washington Hospitals, 1963-72. Medicine. 1977;56:287-313.
11. Sachdev M, Peterson G, Jollis J. Imaging techniques for diagnosis of infective endocarditis. Infect Dis Clin N Am. 2002:16:319-37.
12. Chirillo F, Bruni A, Giujusa T, Totis O, Cavarzerani A, Stritoni P. Echocardiography in infective endocarditis: reassesment of the diagnostic criteria of vegetation as evaluated from the precordial and transesophageal approach. Am J Card Imaging. 1995;9:174-9.
13. Morguet AJ, Werner GS, Andreas S, Kreuzer H. Diagnostic value of transesophageal compared with transthoracic echocardiography in suspected prosthetic valve endocarditis. Herz. 1995;20:390-8.
14. Benn M, Hagelskjaer LH, Tvede M. Infective endocarditis, 1984 through 1993: a clinical and microbiological survey. J Intern Med. 1997;242:15-22.
15. Miró J, del Río A, Mestres C. Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infect Dis Clin N Am. 2002;16:273-95.
16. Fernández N, Almirante B, Tornos P, Pigrau C, Sambola A, Igual A, et al. Contemporary epidemiology and prognosis of health-care associated infective endocarditis. Clin Infect Dis. 2008;47:1287-97.
17. Giannitsioti E, Skiadas I, Antoniadou A, Tsiodras K, Kanavos H, Triantafyllidi H, et al. Nosocomial vs. community-acquired infective endocarditis in Greece: changing epidemiological profile and mortality risk. Clin Microbiol Infect. 2007;13:736-69.
18. Schechner V, Nobre V, Kaye K, Leshno M, Giladi M, Rohner P, et al. Gram-negative bacteremia upon hospital admission: when should Pseudomonas aeruginosa be suspected? Clin Infect Dis. 2009;48:580-6.
19. Bayer AS, Norman DC. Valve-site specific pathogenic differences between right-sided and left-sided bacterial endocarditis. Chest. 1990;98:200-5.
20. Bicanic TA, Eykyn SJ. Hospital-acquired, native valve endocarditis caused by Pseudomonas aeruginosa. J Infect. 2002;44:137-9.
21. Gavin PJ, Suseno MT, Cook FV, Peterson LR, Thomson RB. Left-sided endocarditis caused by Pseudomonas aeruginosa: successful treatment with meropenem and tobramycin. Diagn Microbiol Infect Dis. 2003;47:427-30.
22. Paul M, Grozinsky S, Soares-Weiser K, Leibovici L. Beta lactam antibiotic monotherapy versus betalactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev. 2006:CD003344.
23. Falagas M, Matthaiou D, Bliziotis I. The role of aminoglycosides in combination with a beta-lactam for the treatment of bacterial endocarditis: a meta-analysis of comparative trials. J Antimicrob Chemother. 2006;57:639-47.
24. Safdar N, Handelsman J, Maki D. Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis. 2004; 4:519-27.
25. Kiffer CR, Mendes C, Kuti JL, Nicolau P. Pharmacodynamic comparisons of antimicrobials against nosocomial isolates of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa from the MYSTIC surveillance program: the OPTAMA program, South America 2002. Diagn Microbiol Infect Dis. 2004;49:109-16.
26. Nicolau DP. Pharmacokinetic and pharmacodynamic properties of meropenem. Clin Infect Dis. 2008;47:S32-40.
27. Keam SJ. Doripenem: a review of its use in the treatment of bacterial infections. Drugs. 2008;68:2021-57.
28. Horiuchi M, Kimura M, Tokumura M, Hasebe N, Arai T, Abe K. Absence of convulsive liability of doripenem, a new carbapenem antibiotic, in comparison with beta lactam antibiotics. Toxicology. 2006;222:114-24.
29. Alexiou C, Langley SM, Stafford H, Lowes JA, Livessey SA, Monro JL. Surgery for active culture-positive endocarditis: determinants of early and late outcome. Ann Thorac Surg. 2000;69:1448-54.
30. Olaison L, Pettersson G. Current best practices and guidelines. Indications for surgical intervention in infective endocarditis. Infect Dis Clin N Am. 2002;16:453-75.
31. Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, et al. Risk of embolism and death in infective endocarditis: prognostic value of echocardiography: a prospective multicenter study. Circulation. 2005;112:69-75.
32. Baddour LM, Wilson WR, Bayer AS. Infective endocarditis. Diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005;111:e394-434.
33. Eishi K, Kawazoe K, Kuriyama Y, Kitoh Y, Kawashima Y, Omae T. Surgical management of infective endocarditis associated with cerebral complications. Multi-center retrospective study in Japan. J Thorac Cardiovasc Surg. 1995;110:1745-55.
34. Sexton D, Spelman D. Current best practices and guidelines. Assessment and management of complications in infective endocarditis. Infect Dis Clin N Am. 2002;16:507-21.
Cómo citar
1.
Ordóñez KM, Hernández OA, Cortés JA, López MJ, Alfonso G, Junca A. Endocarditis infecciosa izquierda por Pseudomonas aeruginosa tratada médicamente. biomedica [Internet]. 1 [citado 1 de diciembre de 2020];30(2):164-9. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/179
Sección
Presentación de caso