2019 Research Forum

STENOTROPHOMONAS MALTOPHILA BACTEREMIA WITH SUSPECTED ENDOCARDITIS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILATOR AND CONGESTIVE HEART FAILURE SECONDARY TO AMPHETAMINE ABUSE

Ahana Sandhu MD R3, Kieran Doyle MS IV, Kathleda Tangonan MS IV, Tiffany Win MD, Fowrooz Joolhar MD, Arash Heidari MD Department of Medicine, Kern Medical, Bakersfield, CA United States

Introduction

Conclusions It therefore is of the greatest importance to be aware of this microbe when dealing with patients with multiple co- morbid conditions, immunocompromised state, and indwelling central venous catheters, to ensure that timely initiation of appropriate antibiotic regimens can be initiated to prevent further resistance and decrease the morbidity and mortality for the patient. Discussion Transthoracic and Transesophageal echoes done did not show any vegetations on the leads or any valvular involvement. This patient was continued on long term antibiotics and he saw improvement in his symptoms. 1) Takigawa M, Noda T, Kurita T, Okamura H, Suyama K, Shimizu W, Aihara N, Nakajima H, Kobayashi J, Kamakura S: Extremely Late Pacemaker-Infective Endocarditis due to Stenotrophomonas maltophilia. Cardiology 2008;110:226-229. doi: 10.1159/000112404 2) Jaidane, N., Chaouech, C., Naija, W., Boujaafar, N., and Bouallegue, O. (2014). Stenotrophomonas maltophilia bacteraemia: analysis of 33 episodes occurred in the ICU at the University Hospital in Sousse, Tunisia. OALib J. 1:e954. doi: 10.4236/oalib.1100954 3) Di Bonaventura, G., Spedicato, I., D'Antonio, D., Robuffo, I., and Piccolomini, R. (2004). Biofilm formation by Stenotrophomonas maltophilia: modulation by quinolones, trimethoprim-sulfamethoxazole, and ceftazidime. Antimicrob. Agents Chemother. 48, 151– 160. doi: 10.1128/AAC.48.1.151-160.2004 4) Crossman, L. C., Gould, V. C., Dow, J. M., Vernikos, G. S., Okazaki, A., Sebaihia, M., et al. (2008). The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. Genome Biol. 9,:R74. doi: 10.1186/gb- 2008-9-4-r74 5) Buege, M., Bushman, A.M., Best, L., & Wall, G.C. (2016). Implantable cardioverter defibrillator pocket infection caused by Stenotrophomonas maltophilia. 6. )https://www.mayoclinic.org/tests- procedures/implantable-cardioverter- defibrillators/about/pac-20384692 7).https://my.clevelandclinic.org/health/treatments/14 983-peripherally-inserted-central-catheter-picc 8. )Stenotrophomonas mallophilia images from www.scielo.cl, clinicalmicrobiology.stanforrd.edu, microelibrary.org References

Discussion

Purpose Multi drug resistant with the capacity to form a biofilm are is a characteristics of this aerobic, nonfermentive, Gram- negative bacterium known as Stenotrophomonas maltophilia. With a reputation of being a causative agent in difficult to treat infections which span across the spectrum of cellulitis to bacteremia, with an effect known to be deadly in the immunocompromised population, this microbe is a noteworthy contender for the list of bacteria that clinicians need to be aware of when dealing with immunocompromised patients with indwelling catheters or implantable cardiac devices. Although not a common culprit behind these conditions, it is critical that the clinician remember to keep this bacterium in the differential, due to the significant mortalityassociated with missing the diagnosis. Discussion We here report a case of a 23-year-old male with congestive heart failure with reduced ejection fraction. He recently has placement of an Implantable cardioverter defibrillator and peripherally inserted central catheter (PICC) for ionotropic support with milrinone. He presented to the emergency department with episodes of intermittent chills and his lab work was remarkable for two blood cultures that grew Stenotrophomonas melophilia. The culture and sensitivities revealed the microbe to be susceptible to Bactrim and Ceftazidime and this patient was started on the appropriate antibiotic regimen. The PICC line was removed, along with the ICD to ensure complete resolution of the bacteremia and prevention of biofilm formation on the foreign objects.

Figure 1. Culture and sensitivity results from our patient’s PICC line showing growth of Stenotrophomonas maltophilia, which matched the blood culture results.

111