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Infective Endocarditis Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report
Infection and Drug Resistance ( IF 3.9 ) Pub Date : 2021-08-25 , DOI: 10.2147/idr.s321443 Tsuneaki Kenzaka 1, 2 , Yuto Shinkura 1 , Shizuo Kayama 3, 4, 5 , Liansheng Yu 3, 4, 5 , Sayoko Kawakami 3 , Motoyuki Sugai 3, 4, 5 , Satoru Kawasaki 1
Infection and Drug Resistance ( IF 3.9 ) Pub Date : 2021-08-25 , DOI: 10.2147/idr.s321443 Tsuneaki Kenzaka 1, 2 , Yuto Shinkura 1 , Shizuo Kayama 3, 4, 5 , Liansheng Yu 3, 4, 5 , Sayoko Kawakami 3 , Motoyuki Sugai 3, 4, 5 , Satoru Kawasaki 1
Affiliation
Introduction: Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) reportedly accounts for > 20% of E. coli infections and 2.0% of infective endocarditis cases. Nonetheless, there is a global paucity of reports on infective endocarditis caused by ESBL-EC.
Case: An 83-year-old Japanese man who underwent mitral annuloplasty for mitral valve prolapse 5 years ago developed a fever of 38.5°C. The patient was hospitalized the first time for pyelonephritis and bacteremia due to ESBL-EC and treated successfully with the antimicrobial meropenem for 14 days. Two days after discharge, however, the patient was re-admitted with bacteremia due to ESBL-EC. He was treated successfully with the antimicrobial cefmetazole for 14 days. The patient was admitted to our institution for a third time due to bacteremia again, a day after discharge following meropenem antibiotic therapy. Transesophageal echocardiography showed vegetation in the anterior mitral valve annulus. Magnetic resonance imaging of the head showed septic cerebral embolism. The patient was diagnosed with infective endocarditis due to ESBL-EC and underwent mitral valve replacement. After 6 weeks of antibiotic therapy with meropenem and tobramycin, the patient recovered completely. The causative E. coli strain MS6396 was identified as the E. coli clone ST131 by multilocus sequence typing and confirmed the presence of blaCTX-M-27 ESBL gene.
Conclusion: Only six cases of infective endocarditis associated with ESBL-EC have been reported in the past. Moreover, this is the first report of a patient with infective endocarditis bacteriologically or genetically analyzed for ESBL-EC. In future, factors that may cause infective endocarditis in ESBL-EC infections may be clarified through more thorough bacteriological/genetic analyses of ESBL-EC.
Keywords: blaCTX-M-27 ESBL, ST131, E. coli, meropenem, infective endocarditis, bacteremia
中文翻译：
由产超广谱β-内酰胺酶的大肠杆菌引起的感染性心内膜炎：病例报告
简介：据报道，产超广谱 β-内酰胺酶的大肠杆菌(ESBL-EC) 占大肠杆菌感染的 20% 以上和感染性心内膜炎病例的 2.0%。尽管如此，全球缺乏关于 ESBL-EC 引起的感染性心内膜炎的报道。
案子：一名 83 岁的日本男性 5 年前因二尖瓣脱垂接受了二尖瓣瓣环成形术，发烧 38.5°C。患者因 ESBL-EC 引起的肾盂肾炎和菌血症第一次住院，并使用抗菌美罗培南治疗 14 天成功。然而，出院两天后，患者因 ESBL-EC 菌血症再次入院。他用抗菌头孢美唑成功治疗了 14 天。在美罗培南抗生素治疗后的第二天，患者再次因菌血症第三次入院。经食道超声心动图显示二尖瓣环前部有赘生物。头部磁共振成像显示脓毒性脑栓塞。该患者因 ESBL-EC 被诊断为感染性心内膜炎，并接受了二尖瓣置换术。用美罗培南和妥布霉素抗生素治疗 6 周后，患者完全康复。病因大肠杆菌菌株MS6396通过多位点序列分型鉴定为大肠杆菌克隆ST131，并证实了bla CTX-M-27 ESBL基因的存在。
结论：过去仅报道了 6 例与 ESBL-EC 相关的感染性心内膜炎。此外，这是对感染性心内膜炎患者进行 ESBL-EC 细菌学或基因分析的第一份报告。将来，可能通过对 ESBL-EC 进行更彻底的细菌学/遗传分析来阐明可能导致 ESBL-EC 感染的感染性心内膜炎的因素。
关键词： bla CTX-M-27 ESBL，ST131，大肠杆菌，美罗培南，感染性心内膜炎，菌血症
更新日期：2021-08-25
Case: An 83-year-old Japanese man who underwent mitral annuloplasty for mitral valve prolapse 5 years ago developed a fever of 38.5°C. The patient was hospitalized the first time for pyelonephritis and bacteremia due to ESBL-EC and treated successfully with the antimicrobial meropenem for 14 days. Two days after discharge, however, the patient was re-admitted with bacteremia due to ESBL-EC. He was treated successfully with the antimicrobial cefmetazole for 14 days. The patient was admitted to our institution for a third time due to bacteremia again, a day after discharge following meropenem antibiotic therapy. Transesophageal echocardiography showed vegetation in the anterior mitral valve annulus. Magnetic resonance imaging of the head showed septic cerebral embolism. The patient was diagnosed with infective endocarditis due to ESBL-EC and underwent mitral valve replacement. After 6 weeks of antibiotic therapy with meropenem and tobramycin, the patient recovered completely. The causative E. coli strain MS6396 was identified as the E. coli clone ST131 by multilocus sequence typing and confirmed the presence of blaCTX-M-27 ESBL gene.
Conclusion: Only six cases of infective endocarditis associated with ESBL-EC have been reported in the past. Moreover, this is the first report of a patient with infective endocarditis bacteriologically or genetically analyzed for ESBL-EC. In future, factors that may cause infective endocarditis in ESBL-EC infections may be clarified through more thorough bacteriological/genetic analyses of ESBL-EC.
Keywords: blaCTX-M-27 ESBL, ST131, E. coli, meropenem, infective endocarditis, bacteremia
中文翻译：
由产超广谱β-内酰胺酶的大肠杆菌引起的感染性心内膜炎：病例报告
简介：据报道，产超广谱 β-内酰胺酶的大肠杆菌(ESBL-EC) 占大肠杆菌感染的 20% 以上和感染性心内膜炎病例的 2.0%。尽管如此，全球缺乏关于 ESBL-EC 引起的感染性心内膜炎的报道。
案子：一名 83 岁的日本男性 5 年前因二尖瓣脱垂接受了二尖瓣瓣环成形术，发烧 38.5°C。患者因 ESBL-EC 引起的肾盂肾炎和菌血症第一次住院，并使用抗菌美罗培南治疗 14 天成功。然而，出院两天后，患者因 ESBL-EC 菌血症再次入院。他用抗菌头孢美唑成功治疗了 14 天。在美罗培南抗生素治疗后的第二天，患者再次因菌血症第三次入院。经食道超声心动图显示二尖瓣环前部有赘生物。头部磁共振成像显示脓毒性脑栓塞。该患者因 ESBL-EC 被诊断为感染性心内膜炎，并接受了二尖瓣置换术。用美罗培南和妥布霉素抗生素治疗 6 周后，患者完全康复。病因大肠杆菌菌株MS6396通过多位点序列分型鉴定为大肠杆菌克隆ST131，并证实了bla CTX-M-27 ESBL基因的存在。
结论：过去仅报道了 6 例与 ESBL-EC 相关的感染性心内膜炎。此外，这是对感染性心内膜炎患者进行 ESBL-EC 细菌学或基因分析的第一份报告。将来，可能通过对 ESBL-EC 进行更彻底的细菌学/遗传分析来阐明可能导致 ESBL-EC 感染的感染性心内膜炎的因素。
关键词： bla CTX-M-27 ESBL，ST131，大肠杆菌，美罗培南，感染性心内膜炎，菌血症
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