Endocarditis Due to Burkholderia Cepacia Infection: A Case Report

Endocarditis is a condition affecting the endocardium, potentially involving the heart valves, usually after bacteria enter the bloodstream and adhere to damaged areas. Major risk factors include pre-existing valvular disease, prosthetic valves, congenital heart disease, immunosuppression, and intravenous drug use. The most common pathogens include Staphylococcus aureus, Streptococcus viridans, Enterococcus spp., and Staphylococcus epidermidis. Burkholderia cepacia is a gram-negative bacillus associated with nosocomial infections and is a rare cause of infective endocarditis. We report the case of a 55-year-old man with a history of repair of a ruptured aneurysm 7 years earlier, including aortic valve replacement and reimplantation of the coronary arteries. Two years after that procedure, he developed possible prosthetic aortic valve endocarditis with negative blood cultures, treated empirically with gentamicin and ceftriaxone, with good clinical evolution. Approximately 40 days before the current admission, he developed fever (up to 39°C) without other associated symptoms. He denied dyspnea, chest pain, syncope, or weight loss. On examination, he had a 4+/4+ systolic-diastolic murmur. Transesophageal echocardiography revealed vegetations on the bioprosthetic valve, leaflet rupture, and severe aortic regurgitation. Blood cultures remained negative. Cefepime 2g every 8 hours and daptomycin 500 mg/day were initiated, and repeat valve replacement was indicated, performed three days after admission without intraoperative complications. In the immediate postoperative period, he developed refractory shock and cardiorespiratory arrest, without response to resuscitation and died. Culture of sonicated valve material grew Burkholderia cepacia. This was a case of infective endocarditis due to Burkholderia cepacia with negative blood cultures, confirmed by culture of sonicated valve material. It is a rare entity with unfavorable outcome, highlighting the complexity of managing prosthetic valve endocarditis and its association with nosocomial infections.