Tuesday, August 09, 2005

Choices of ABTx

We were consulted to see this is 72-year-old man following emergent aortic valve replacement. He had had a CABG in 2000 and ha done extremely well until approximately two to three weeks PTA when he began experiencing increasing shortness of breath and dyspnea on exertionre. He was seen by cardiology and a 2-D-ECHO revealed aortic insufficiency and possible signs of Valsalva to left atrial fistula. He had an emergent valve replacement and we were consulted because the valve appeared grossly infected and intra-op swabs revealed GPCs in chains and yeast on smears.
He was intubated and on pressors post-op. What would you like to know and what ABTx would you recommend?

4 comments - CLICK HERE to read & add your own!:

Mendez said...

I'd like to know what seeded his valve. Any intavascular devices? status of his dentition? drug use?

Since the valve is replaced - we are no longer using recommended medical Rx lengths endocarditis. Until we have an ID and evaluated for source of seeding, I would double cover (penicillin and aminoglycoside).

Mike L said...

Just out of curiosity, why were you consulted for this ID issue?

I agree with MM. Does he have a source of any endovascular infection (including walking barefoot in Tennessee) or have any recent procedures.

Baleeiro said...

No devices or lines. Previously quasi-healthy obese, sedentary, diabetic male. We certainly double-covered but what about the yeast?
We don't have any ID specialist here so we often get the "ID" consults.

Jeff H said...

Generally, the treatment of fungal endocarditis is valve replacement. As for the yeast--I can't say I've come across candidal endocarditis, but he is diabetic. Are blood cultures positive for yeast? As he's sick, I'd cover (probably with Ampho or Voriconazole) pending final cultures. Also, I'd add Vanc for the GPC's, as about 40% of Strep pneumo isolates are now PCN resistant. If it comes back sensative to PCN, the Vanc can be stopped.