SHM Converge Scientific Abstract ePoster Gallery-The Uti With a Murmur: Proteus Vulgaris Bacteremia Leading to Native Valve Endocarditis

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This case report describes a 69-year-old African American woman with diabetes, a chronic indwelling urinary catheter, recurrent catheter-associated UTIs, sacral ulcer infection, and bedbound status who presented with acute altered mental status, hypotension, and tachycardia. She was found to have septic shock with leukocytosis, severe anemia, hypoglycemia, and very elevated procalcitonin. CT imaging showed sacral osteomyelitis with abscesses. Because of her history of recurrent urosepsis, blood cultures were obtained and again grew <strong>Proteus vulgaris</strong>.

Given persistent gram-negative bacteremia, echocardiography was performed and revealed an <strong>8-mm vegetation on the noncoronary cusp of the aortic valve</strong>, confirming <strong>native valve infective endocarditis</strong>. Her antimicrobial therapy was narrowed to a <strong>carbapenem-based regimen</strong> based on sensitivities, consistent with a multidrug-resistant organism.

The report emphasizes that infective endocarditis is a life-threatening infection most often caused by <em>Staphylococcus aureus</em> or viridans streptococci, but gram-negative organisms are uncommon and <em>Proteus</em> species account for only a small fraction of cases. <em>Proteus vulgaris</em> endocarditis is especially rare. Gram-negative IE is associated with significant mortality due to delayed diagnosis, antimicrobial resistance, and limited evidence to guide treatment. Surgical intervention is often needed, though optimal antibiotic duration remains uncertain.

The authors conclude that clinicians should maintain a high index of suspicion for endocarditis in patients with persistent gram-negative bacteremia, especially those with chronic urinary catheters or recurrent UTIs. Early echocardiography and prompt, sensitivity-guided antibiotic adjustment are critical to improving outcomes.

Asset Subtitle

Mohamed Abdel Latif

Meta Tag

Author List Arthur Aelncar, Joseph Noonan, Kristen Roberts, Mohamed Abdel Latif, Yash Sarda

Category Clinical Vignettes

Concept Persistent Gram-negative bacteremia

Concept Infective Endocarditis

Concept Gram-negative Bacterium

Concept Echocardiography

Concept Proteus

Distinguished Non-Finalist

Presenter Organization Baptist Memorial Hospital

Presenting Author Mohamed Abdel Latif

Track Adult

Keywords

Proteus vulgaris

infective endocarditis

native valve

aortic valve vegetation

gram-negative bacteremia

septic shock

chronic urinary catheter

recurrent urinary tract infection

carbapenem therapy

sacral osteomyelitis

Persistent Gram-negative bacteremia

Infective Endocarditis

Gram-negative Bacterium

Echocardiography

Proteus