2019 Research Forum

Presenter: Ahana Sandhu MD R3 Principal Investigator & Faculty Sponsor: Arash Heidari MD

Stenotrophomonas Maltophilia Bacteremia with Suspected Endocarditis in a Patient with an Implantable Cardioverter Defibrillator and Congestive Heart Failure Secondary to Amphetamine Use

Ahana Sandhu MD R3, Kieran Doyle MS IV, Kathleda Tangonan MS IV, Tiffany Win MD, Fowrooz Joolhar MD, Arash Heidari MD

INTRODUCTION 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. PURPOSE 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 mortality associated 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. Transthoracic and Transesophageal echoes done did not show any vegetations on the leads or any valvular involvement. This patient continued on long-term antibiotics and he saw improvement in his symptoms. CONCLUSION 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.

110