Left-sided infective endocarditis caused by Pseudomonas aeruginosa treated medically
Keywords:
endocarditis, Pseudomonas aeruginosa, aortic valve, embolism, combined modality therapy, mortality
Abstract
Infective endocarditis due to Pseudomonas aeruginosa is a rare clinical condition, difficult to diagnose and associated with high mortality. Herein we present a case of a 51 years old male without history of intravenous drug use or valvular disease, with past medical history of cholecystectomy in the previous month, who presented to the emergency department with fever, gastrointestinal symptoms, and subsequent signs of distant embolization, positive blood cultures for P. aeruginosa and development of multiple complications of the disease. The clinical presentation of infective endocarditis is nonspecific, leading to delayed diagnosis, and preventing early and effective treatment. Valvular replacement is indicated in fungal or P. aeruginosa endocarditis. This case is notable because of the resolution with amikacin combined with meropenem, in a patient with several complications that contraindicated surgery.Downloads
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References
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.
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.
How to Cite
1.
Ordóñez KM, Hernández OA, Cortés JA, López MJ, Alfonso G, Junca A. Left-sided infective endocarditis caused by Pseudomonas aeruginosa treated medically. biomedica [Internet]. 2010 Aug. 4 [cited 2024 May 11];30(2):164-9. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/179
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