Recurrent Infective endocarditis of the native aortic valve due to ESBL producing Escherichia coli (e coli) after therapeutic ERCP.

We describe the first case of ESBL producing E coli endocarditis of the native aortic valve in which prophylaxis was performed according to currently available guidelines. A 75 year-old woman presented at our emergency department with a two week complaint of fever, fatigue, anorexia, diffuse abdominal pain after ERCP therapeutic. The initial laboratory examinations showed increased levels of ESR, CRP, fibrinogen, alkaline phosphatase, gammaGT, aspartate aminotransferase, alanine aminotransferase and direct fraction of bilirubin. Two blood cultures were positive for ESBL-producing E coli. The abdominal sonography revealed intrahepatic biliary tree dilation, cholecystectomy and minimal aerobilia in the left liver lobe. A transthoracic echocardiogram showed a small vegetation adherent to the aortic valve and a moderate amount of aortic and mitral regurgitation. Treatment with imipenem/cilastatin for 35 days was performed with a favorable outcome. During this period she underwent endoscopic metal stenting to replace the plastic tube. The patient was discharged after 40 days of hospitalization.

CONCLUSIONS

Patients with high risk also for endocarditis and infections or bowel colonization with multiple drug resistant Enterobacteriaceae such as ESBL- producing E coli that have undergone multiple and repetitive therapeutic procedures are at risk for endocarditis with this type of bacteria. Prophylaxis and therapy with appropriate antibiotics must be considered in these patients.