Abstract Introduction the most common bacteria in infective endocarditis (IE) is Staphylococcus aureus. Signs and symptoms of infective endocarditis can often be non-specific and difficult to identify. Untreated methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and endocarditis can result in significant complications including valvular destruction, septic emboli, static infection and death. Patient Case A 75-year-old male with a history of alcohol use disorder, hypertension, and lumbar stenosis with recent laminotomy was admitted for severe sepsis with acute encephalopathy. Also presented with acute-on-chronic low back pain and found to have a superficial lumbar spine wound. The patient met Duke’s criteria with positive blood cultures for Staphylococcus aureus and Transesophageal echocardiography (TEE) demonstrated mitral valve vegetation with leaflet destruction (Figure 1). MRI spine showed multiple small rim-enhancing fluid collections, and MRI brain demonstrated multi-embolic cerebrovascular accident (Figure 2). It was difficult to identify the source of infection—hematogenous, valvular vegetation, or spinal procedure. He was treated by a multidisciplinary team including Cardiothoracic surgery, Infectious Disease, Cardiology, Neurology, and Neurosurgery. To control the source of infection, spinal abscess was drained by interventional radiology. However, due to ongoing symptoms, neurosurgery evaluated the case and decided that intervention is not indicated. Then, the patient underwent sternotomy with valvular repair. Aortic valve vegetation was incidentally found during surgery and was also replaced. The patient completed cefazolin for 12 weeks and then switched to Cefalexin outpatient. The patient had a re-admission for worsening back pain and received redo L3-L5 laminectomy with debridement of infected tissue along with an extended course of cefazolin. Fortunately, after this complex clinical course, the patient ultimately recovered and returned to baseline health. Discussion MSSA bacteremia with cardiac involvement carries a higher risk for embolic events and mortality compared to other organisms. MSSA IE may experience neurological complications including ischemia, encephalopathy/meningitis, hemorrhages, and brain abscesses along with high risk for mortality. The patient’s clinical course was complicated by recent spinal surgery, which may have served as a nidus of infection. The Infectious Diseases Society of America recommends prolonged IV antibiotic therapy for complicated IE and could be minimally 8 weeks if there is spinal involvement along with surgical intervention in cases of valvular destruction or persistent embolization despite appropriate therapy. Conclusion Prompt identification and treatment of MSSA bacteremia with multiple complications is a necessary skill for all physicians and requires coordination of multiple subspecialties for optimal care. This abstract is funded by: None
Sabbagh et al. (Fri,) studied this question.
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