Emergency Department Diagnosis of Septic Pulmonary Embolism due to Infectious Endocarditis Using Bedside Ultrasound

Infective endocarditis by Klebsiella species: a systematic review

This study aimed to systematically analyze all cases of infective endocarditis (IE) by Klebsiella species in the literature. A systematic review of PubMed, Scopus and Cochrane library (through 27^th January 2021) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE by Klebsiella species was performed. In this review, a total of 66 studies were included, providing data for 67 patients. A prosthetic valve was present in 16.4%, while the most common causative pathogen was K. pneumoniae followed by K. oxytoca. The aortic valve was the most commonly infected intracardiac site, followed by the mitral valve. The diagnosis was based on transthoracic echocardiography in 46.2%, while the diagnosis was set at autopsy in 9.2% of included patients. Blood cultures were positive in 93.8%. Fever and sepsis were the most frequent clinical presentations, followed by embolic phenomena, paravalvular abscess, and heart failure. Cephalosporins, aminoglycosides, and carbapenems were the most frequently used antimicrobials. Surgical treatment along with antimicrobials was performed in 37.3% of included patients. Clinical cure was noted in 80.3%, while the overall mortality was 19.4%. Infection at the aortic valve was independently associated with mortality by IE. This systematic review gives a comprehensive description of IE by Klebsiella and provides information on epidemiology, clinical manifestations, therapeutic strategies and their outcomes.

A case of septic pulmonary embolism caused by P. aeruginosa in a hemodialysis patient and review of the literature

Background

Septic pulmonary embolism (SPE) is an uncommon but serious complication resulting from infection of the blood. Gram-positive cocci, including methicillin-susceptible Staphylococcus aureus and methicillin-resistant Staphylococcus aureus, are the most common causative organisms of SPE. Few case reports have been published on SPE caused by Pseudomonas aeruginosa (P. aeruginosa), and thus, the consensus treatment of SPE caused by P. aeruginosa infections remains undetermined. Management of P. aeruginosa infection can be challenging due to its poor prognosis and antimicrobial resistance. Here, we report a case of successful combination antibiotic therapy for SPE associated with infective endocarditis (IE) caused by P. aeruginosa in a hemodialysis patient, with a review of the literature.

Case presentation

A 62-year-old man receiving maintenance hemodialysis as treatment for end-stage renal disease due to IgA nephropathy was admitted to our hospital with high fever and chills lasting 10 days. Chest computed tomography revealed multiple nodular shadows, and gram-negative rods were confirmed by blood culture obtained on admission. We suspected SPE and initiated meropenem (MEPM) treatment. P. aeruginosa was identified in blood cultures, and transesophageal echocardiography demonstrated vegetation on the tricuspid valve. Therefore, a diagnosis of SPE associated with IE caused by P. aeruginosa was made. P. aeruginosa isolates showed good susceptibility to MEPM, but no symptomatic improvement was observed. Thus, antibiotics were changed from MEPM to a combination of ceftazidime and tobramycin (TOB). The patient exhibited a favorable response to the combination therapy, although we discontinued TOB on day 23 because of tinnitus symptoms.

Conclusions

We report a rare case of SPE associated with IE caused by P. aeruginosa in a hemodialysis patient. Combination antibiotic therapy may be effective in this situation.