SHM Converge Scientific Abstract ePoster Gallery-Serratia, Sepsis, and a Struggling Mitral Valve: A Rare Case of Infective Endocarditis

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This case report describes a 51-year-old man with a rare episode of infective endocarditis caused by <strong>Serratia marcescens</strong>. He presented to the emergency department with several days of fever, chills, and generalized malaise. His history was significant for prior <strong>Streptococcus constellatus mitral valve endocarditis</strong> treated with long-term IV antibiotics, as well as intravenous drug use, diabetes, hyperlipidemia, anemia, epilepsy, and medication noncompliance. On exam, he had poor dentition and a systolic murmur, but no peripheral stigmata of endocarditis.

Laboratory testing showed leukocytosis and markedly elevated inflammatory markers. Two admission blood cultures grew <strong>gram-negative bacilli identified as Serratia marcescens</strong>, with resistance to ampicillin-sulbactam, cefazolin, and cefuroxime, but susceptibility to ceftriaxone, ciprofloxacin, gentamicin, levofloxacin, and ertapenem. A transesophageal echocardiogram revealed a <strong>1.5 cm mobile vegetation on the anterior leaflet of the mitral valve</strong>, prolapsing into the left ventricular outflow tract.

The patient was started on broad-spectrum antibiotics and improved significantly, with complete symptom resolution before discharge. Cardiothoracic surgery evaluated him for possible valve intervention, but no surgery was recommended because of his clinical improvement. A PICC line was placed, and he was discharged to complete <strong>6 weeks of IV ertapenem</strong> after blood cultures cleared. He remained well on follow-up.

The authors emphasize that <strong>Serratia endocarditis is rare but serious</strong>, often associated with healthcare exposure or intravenous drug use, and it may involve the left side of the heart despite the more common right-sided pattern in IVDU. They note its high mortality and the importance of urgent surgical evaluation and close follow-up to reduce complications such as heart failure and renal failure from septic emboli.

Asset Subtitle

Mohammed O. Choudary

Meta Tag

Author List Ben Hur Aguilar, Georgy Mathew, Mohammed O. Choudary, Rohab Sohail, Taimur Bayar-Masood, Tyler Faimon

Category Clinical Vignettes

Concept Serratia marcescens

Concept Infective Endocarditis

Concept Targeted intravenous antibiotics

Concept Intravenous Drug Use

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Mohammed O. Choudary

Track Adult

Keywords

Serratia marcescens

infective endocarditis

mitral valve vegetation

intravenous drug use

bacteremia

transesophageal echocardiogram

IV ertapenem

gram-negative bacilli

rare endocarditis

cardiothoracic surgery

Serratia marcescens

Infective Endocarditis

Targeted intravenous antibiotics

Intravenous Drug Use

Blood Culture