SHM Converge Scientific Abstract ePoster Gallery-The Deceptive Contaminant: Staphylococcus Epidermidis Prosthetic Valve Endocarditis Leading to Aortic Root Abscess and Intracardiac Fistula

The Deceptive Contaminant: Staphylococcus Epidermidis Prosthetic Valve Endocarditis Leading to Aortic Root Abscess and Intracardiac Fistula

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This case report describes a fatal episode of prosthetic valve endocarditis caused by <em>Staphylococcus epidermidis</em> in a 76-year-old woman with a bioprosthetic aortic valve, ESRD on hemodialysis, coronary artery disease, and an ICD. The report highlights a major diagnostic pitfall: coagulase-negative staphylococci are often dismissed as blood-culture contaminants, even though they are a leading cause of prosthetic valve infection and can represent true endocarditis.

The patient initially had a single positive blood culture for <em>S. epidermidis</em>, which was interpreted as contamination. When recurrent MRSE bacteremia developed, vancomycin was started and transesophageal echocardiography was performed. TEE revealed a large prosthetic valve vegetation, extensive periannular aortic root abscess, prosthetic valve dehiscence, and fistulous extension into the right atrium, indicating advanced destructive infection.

The discussion emphasizes that CoNS infections of prosthetic valves are difficult to eradicate because of biofilm formation, impaired antibiotic penetration, and immune evasion. Even a single positive culture in a high-risk patient should prompt careful evaluation, including early TEE. Periannular abscess, valve dehiscence, and fistula formation signal complicated endocarditis and often require urgent surgical source control.

Despite persistent bacteremia and antibiotic therapy, the patient was not a surgical candidate. She suffered cardiac arrest on hospital day 21 and died from progressive prosthetic valve endocarditis complicated by aortic root abscess and intracardiac fistula. The authors conclude that early recognition and timely surgery are the only proven strategies to reduce mortality in complicated prosthetic valve endocarditis.

Asset Subtitle

David Kornblum

Meta Tag

Author List Ambika Eranki, David Kornblum, Israel Rosero Basurto, Maria F. Rosero Basurto

Category Clinical Vignettes

Concept Coagulase-Negative Staphylococci

Concept Prosthetic valve endocarditis

Concept Staphylococcus epidermidis

Concept Transesophageal Echocardiography

Concept Biofilm

Distinguished Non-Finalist

Presenter Organization Usf

Presenting Author David Kornblum

Track Adult

Keywords

prosthetic valve endocarditis

Staphylococcus epidermidis

coagulase-negative staphylococci

bioprosthetic aortic valve

hemodialysis

transesophageal echocardiography

aortic root abscess

prosthetic valve dehiscence

intracardiac fistula

biofilm formation

Coagulase-Negative Staphylococci

Prosthetic valve endocarditis

Staphylococcus epidermidis

Transesophageal Echocardiography

Biofilm