Therapeutic challenges in prosthetic valve Granulicatella adiacens endocarditis: a case report and focused review of alternative antimicrobial strategies

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Prosthetic valve Granulicatella adiacens infective endocarditis (n=1). Intervention: Ertapenem and levofloxacin following surgery (and alternative regimens including carbapenems, fluoroquinolones, and linezolid).

Q: What does this research mean for the field?

Evidence supporting alternative antimicrobial regimens, such as carbapenems, fluoroquinolones, and linezolid, for invasive Granulicatella infections remains limited and associated with heterogeneous clinical outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Niamh Reidy; Susan Lapthorne; Sarah Kenny; Timothy Healy; S McLoughlin; Stephen Connolly; Aaron Doherty; Caitriona Hickey; Niamh Mullane; Margaret M. Hannan; Kishore Doddakula; Corinna Sadlier; Jennifer Walsh

doi:10.1016/j.diagmicrobio.2026.117720

October 30, 2026Diagnostic Microbiology and Infectious Disease

Therapeutic challenges in prosthetic valve Granulicatella adiacens endocarditis: a case report and focused review of alternative antimicrobial strategies

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Key result

Ertapenem and levofloxacin successfully treat ceftriaxone-resistant prosthetic valve Granulicatella adiacens endocarditis after surgery.

n=1

Why the study?

Prosthetic valve Granulicatella adiacens infective endocarditis may require deviation from guideline-supported therapy, necessitating a review of published experience with alternative antimicrobial treatment strategies.

Key Points

To describe a case of prosthetic valve Granulicatella adiacens endocarditis requiring non-guideline therapy and review published evidence regarding alternative antimicrobial regimens.
Documented a single clinical case of ceftriaxone-resistant prosthetic valve infective endocarditis requiring surgical and non-standard medical management.
Conducted a focused literature review evaluating published reports of invasive Granulicatella infections managed with non-standard antimicrobial regimens.
The clinical case involved ceftriaxone-resistant endocarditis complicated by drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and linezolid-associated thrombocytopaenia.
The infection was successfully resolved using surgical intervention followed by completion of antimicrobial therapy with ertapenem and levofloxacin.
The literature review identified sparse published data on alternative regimens—most commonly utilizing carbapenems, fluoroquinolones, and linezolid—with heterogeneous clinical outcomes.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A single case of ceftriaxone-resistant prosthetic valve Granulicatella adiacens infective endocarditis alongside a focused review of invasive Granulicatella infections.

I

Intervention

Ertapenem and levofloxacin completed following surgery; review of non-standard alternative antimicrobial regimens (most commonly carbapenems, fluoroquinolones, and linezolid).

Highlights the use of post-surgical ertapenem and levofloxacin for ceftriaxone-resistant prosthetic valve Granulicatella adiacens endocarditis when standard therapy fails or causes severe adverse events, while emphasizing the scarcity of evidence for alternative regimens.

Limitations

Limited published experience with alternative regimens
Heterogeneous outcomes across reports
Limited published experience with alternative treatment strategies
Heterogeneous outcomes across published reports

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Implication

Requires caution with non-standard regimens in prosthetic valve Granulicatella endocarditis; leaves open standardized strategies.

Abstract

PURPOSE: To describe a case of prosthetic valve (PV) Granulicatella adiacens infective endocarditis (IE) requiring deviation from guideline-supported therapy, and review published experience with alternative treatment strategies. METHODS: A case report and focused literature review of Granulicatella IE and other invasive Granulicatella infections treated with non-standard antimicrobial regimens. RESULTS: Ceftriaxone-resistant PVIE was complicated by DRESS syndrome and linezolid-associated thrombocytopaenia. Treatment with ertapenem and levofloxacin was completed following surgery. Literature review identified limited published experience with alternative regimens, most commonly carbapenems, fluoroquinolones and linezolid. Outcomes were heterogeneous across reports. CONCLUSIONS: Evidence supporting alternative treatment strategies for Granulicatella infections remains limited, highlighting the need for further research.

Discussion

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Cite This Study

Reidy et al. (2026) conducted a case report in Prosthetic valve Granulicatella adiacens infective endocarditis (n=1). Ertapenem and levofloxacin following surgery (and alternative regimens including carbapenems, fluoroquinolones, and linezolid) was evaluated. Ertapenem and levofloxacin following surgery successfully completed treatment for ceftriaxone-resistant prosthetic valve Granulicatella adiacens endocarditis.

synapsesocial.com/papers/6aee01569d87f46bb8e69ec6 https://doi.org/10.1016/j.diagmicrobio.2026.117720

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Therapeutic challenges in prosthetic valve Granulicatella adiacens endocarditis: a case report and focused review of alternative antimicrobial strategies

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Therapeutic challenges in prosthetic valve Granulicatella adiacens endocarditis: a case report and focused review of alternative antimicrobial strategies

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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