A Rare Case of Infective Endocarditis and Intracardiac Device Infection by Providencia stuartii With Review of the Literature

Providencia bacteremia is relatively uncommon but can be rapidly fatal and is often polymicrobial. It is usually associated with long-term indwelling catheter use. Infective endocarditis by Providencia is seen even less frequently, and only 1 case was found on a PubMed database search and literature review of Providencia stuartii infective endocarditis, and another with Providencia rettgeri . A 56-year-old African American man with long-standing lower extremity ulcers presented to the hospital for lower extremity weakness and pain. He had been discharged from the hospital 3 weeks prior for local debridement of lower extremity ulcerations with noted maggot infestation and had P stuartii bacteremia at the time with associated wound culture positive for gram-negative bacilli. On repeat admission, blood cultures yielded P stuartii with identical resistance patterns noted on susceptibilities. Transthoracic echocardiogram showed vegetations attached to the ICD lead and large tricuspid valve vegetation. A biopsy of the longstanding nonhealing lower extremity ulcer had findings consistent with pyoderma gangrenosum. The risk of cardiac device-related infection in patients with gram-negative bacteremia is lower than those with gram-positive bacteremia, and routine echocardiography is not recommended, especially when a known alternative source of bacteremia is available. This case highlights the importance of prudence when dealing with patients with cardiac devices, and with those who have a recurrence of bacteremia despite adequate treatment.