What is the clinical evidence from this study?

Study design: Case Report. Population: Early prosthetic mitral valve endocarditis (n=1). Intervention: Imipenem/cilastatin and rifampicin. Primary outcome: Clinical and echocardiographic improvement (disappearance of vegetation).

What does this research mean for the field?

Treatment with rifampicin combined with imipenem/cilastatin can achieve clinical improvement and complete vegetation resolution in multidrug-resistant Klebsiella pneumoniae prosthetic valve endocarditis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the diagnostic approach and successful medical eradication of early mechanical mitral prosthetic valve endocarditis caused by multidrug-resistant Klebsiella pneumoniae complicated by splenic infarction.

August 15, 2026Radiology Case ReportsOpen Access

From diagnostic dilemma to successful management: Early prosthetic mitral valve endocarditis complicated by splenic infarction caused by Klebsiella pneumoniae

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Key result

High-dose imipenem plus rifampicin resolves early Klebsiella mechanical valve endocarditis without surgery.

Why the study?

Early prosthetic valve endocarditis caused by Gram-negative bacilli is an uncommon but life-threatening condition associated with significant diagnostic and therapeutic challenges.

Key Points

To describe the diagnostic approach and successful medical eradication of early mechanical mitral prosthetic valve endocarditis caused by multidrug-resistant Klebsiella pneumoniae complicated by splenic infarction.
Diagnostic evaluation of a 51-year-old woman presenting with persistent fever 1 month after mechanical mitral valve replacement for rheumatic mitral stenosis.
Multimodality imaging protocol incorporating transthoracic echocardiography, transesophageal echocardiography, cinefluoroscopy, contrast-enhanced thoraco-abdomino-pelvic computed tomography, and brain magnetic resonance imaging.
Therapeutic regimen transitioning from initial colistin monotherapy to synergistic high-dose imipenem/cilastatin (1 g every 8 hours) combined with rifampicin (300 mg every 8 hours).
Initial transthoracic echocardiography was nondiagnostic, but transesophageal echocardiography detected an 11 × 4 mm mobile vegetation on the atrial surface of the mechanical mitral prosthesis, and computed tomography confirmed systemic embolization with splenic infarction.
Serial blood cultures isolated multidrug-resistant Klebsiella pneumoniae susceptible only to colistin; targeted colistin monotherapy failed to resolve fever or systemic inflammation.
Escalation to imipenem/cilastatin and rifampicin achieved complete defervescence, progressive normalization of C-reactive protein levels, and complete resolution of the vegetation on day 21 follow-up transesophageal echocardiography without surgical reoperation.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 51-year-old woman with early prosthetic mitral valve endocarditis caused by multidrug-resistant Klebsiella pneumoniae, successfully treated with imipenem/cilastatin and rifampicin.

Intervention

Initial colistin therapy (3 million IU IV every 8 hours), subsequently switched to rifampicin 300 mg every 8 hours combined with imipenem/cilastatin 1 g every 8 hours.

Outcome

Clinical and biological improvement, and disappearance of the vegetation on follow-up transesophageal echocardiography.

Discussion

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Implication

Early targeted therapy with high-dose imipenem and rifampicin successfully treated multidrug-resistant Klebsiella pneumoniae prosthetic valve endocarditis without the need for surgical intervention.

Cite This Study

Hmidouch et al. (2026) conducted a case report in Early prosthetic mitral valve endocarditis (n=1). Imipenem/cilastatin and rifampicin was evaluated on Clinical and echocardiographic improvement (disappearance of vegetation). High-dose imipenem and rifampicin enabled prosthetic sterilization and complete clinical recovery without surgery in a patient with early mechanical prosthetic valve endocarditis due to K pneumoniae.

synapsesocial.com/papers/6a801a2875c2e31742c86aec https://doi.org/10.1016/j.radcr.2026.07.025

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Implication

Early targeted therapy with high-dose imipenem and rifampicin successfully treated multidrug-resistant Klebsiella pneumoniae prosthetic valve endocarditis without the need for surgical intervention.

From diagnostic dilemma to successful management: Early prosthetic mitral valve endocarditis complicated by splenic infarction caused by Klebsiella pneumoniae

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

From diagnostic dilemma to successful management: Early prosthetic mitral valve endocarditis complicated by splenic infarction caused by Klebsiella pneumoniae

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

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