International Journal of Cardiology 197 (2015) 164–165
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Acinetobacter baumannii and cardiac impairment. Increasingly important nosocomial pathogen M. Tempesta a, A. Campanella b, S. Maviglia a,⁎ a b
Division of Anesthesiology and Intensive Care, Hospital San Salvatore, Pesaro, Italy Division of Cardiac Surgery, Hospital SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
a r t i c l e
i n f o
Article history: Received 4 June 2015 Accepted 20 June 2015 Available online 26 June 2015
Infective endocarditis (IE) is a bacterial infection of the endothelial surface of the heart. The incidence of IE varies according to the country from 3 to 10 cases per 100,000 persons/year. Streptococci, staphylococci, enterococci and coccobacilli Gram-negative are the cause of most of IE. In particular it is emerging as a new IE, the nosocomial endocarditis, as a result of new or more widespread therapeutic modalities: intravascular catheters, pacemakers, dialysis shunts, etc. [1–6]. We present a case report of a woman 56 years bearer of biological aortic prosthesis for aortic valve bicuspid stenosis and pacemaker DDDr for atrioventricular block. In his clinical history there was psoriasis, diabetes newly diagnosed, a history of chronic obstructive pulmonary bronchitis with chronic pulmonary heart disease and a history of being a former smoker [7–16].
The patient comes to the emergency room with severe respiratory failure so she was intubated and transferred to the intensive care unit where after about 15 days has persistent high fever. The physical examination showed a systolic murmur 2/6 L ubiquitous. The transesophageal echocardiogram showed a dehiscence of the aortic prosthesis with a small vegetation between the left coronary cusp and the right coronary cusp (Fig. 1) and blood cultures are positive for Acinetobacter baumannii [3–6]. A. baumannii is a gram-negative, non motile coccobacillus. It is widely distributed in the environment. Its ability to survive even in hostile conditions allows it to a wide circulation in the hospital setting, where it is to date the most fearsome germ responsible for nosocomial infections [17–20]. The relevance of this case is focused on the fact that IE sustained by the fearsome coccobacillus A. baumannii is not a frequent but always a possible cause of nosocomial infective endocarditis. Attention should be paid to the asepsis procedures of the intensive care unit.
Conflict of interest The authors report no relationships that could be construed as a conflict of interest.
Fig. 1. Transesophageal echocardiography. Panels A and B: dehiscence of the aortic prosthesis with insufficiency transvalvular moderate. Panel C: small vegetation between the left coronary cusp and the right coronary cusp. ⁎ Corresponding author at: Unità operativa di Anestesia e Rianimazione, Ospedale San Salvatore, Piazzale Cinelli 4, 61121 Pesaro, PU, Italia. Tel.: +39 3407635966. E-mail address: [email protected] (S. Maviglia).
http://dx.doi.org/10.1016/j.ijcard.2015.06.085 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
Letter to the Editor
Acknowledgments The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology References [1] F. Delahaye, V.H. Chu, J. Altclas, B. Barsic, A. Delahaye, T. Freiberger, D.L. Gordon, M.M. Hannan, B. Hoen, S.S. Kanj, T. Lejko-Zupanc, C.A. Mestres, O. Pachirat, P. Pappas, C. Lamas, C. Selton-Suty, R. Tan, P. Tattevin, A. Wang, International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators, One-year outcome following biological or mechanical valve replacement for infective endocarditis, Int. J. Cardiol. 178 (Jan 15 2015) 117–123, http://dx.doi.org/10. 1016/j.ijcard.2014.10.125. [2] M. Mirabel, R. André, P. Barsoum, H. Colboc, F. Lacassin, B. Noel, O. Axler, G. Phelippeau, C. Braunstein, E. Marijon, B. Iung, X. Jouven, Ethnic disparities in the incidence of infective endocarditis in the Pacific, Int. J. Cardiol. 186 (Mar 18 2015) 43–44, http://dx.doi.org/10.1016/j.ijcard.2015.03.243. [3] N. Martins, I.S. Martins, W.V. de Freitas, J.A. de Matos, A.C.G. Magalhães, V.B.C. Girão, R.C.S. Dias, T.C. de Souza, F.L.P.C. Pellegrino, L.D. Costa, C.H.R. Boasquevisque, S.A. Nouér, L.W. Riley, G. Santoro-Lopes, B.M. Moreira, Severe infection in a lung transplant recipient caused by donor transmitted carbapenem-resistant Acinetobacter baumannii, Transpl. Infect. Dis. 14 (3) (June 2012) 316–320. [4] C. Zhao, W. Xie, W. Zhang, Z. Ye, H. Wu, Mechanism of drug resistance of carbapenems-resistant Acinetobacter baumannii and the application of a combination of drugs in vitro, Zhonghua Shao Shang Za Zhi 30 (2) (Apr 2014) 166–170. [5] M.E. Falagas, P. Kopterides, Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature, J. Hosp. Infect. 64 (2006) 7–15. [6] P. Laganà, L. Melcarne, S. Delia, Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance, Int. J. Cardiol. 187 (May 6 2015) 678–679, http://dx.doi.org/10.1016/j.ijcard.2015.04.019. [7] G. Dattilo, M. Scarano, M. Casale, M. Sergi, S. Quattrocchi, M. Parato, E. Imbalzano, An atypical manifestation of Twiddler syndrome, Int. J. Cardiol. 186 (May 1 2015) 1–2, http://dx.doi.org/10.1016/j.ijcard.2015.03.184. [8] G. Dattilo, A. Lamari, V. Tulino, M. Scarano, E. De Luca, D. Mutone, P. Busacca, Congenital valvular heart disease with high familial penetrance, Recenti Prog. Med. 103 (12) (Dec 2012) 581–583, http://dx.doi.org/10.1701/1206.13361. [9] G. Dattilo, A. Lamari, M. Scarano, G. Di Bella, E. Imbalzano, P. Busacca, S. Coglitore, Coronary artery disease and psoriasis, Minerva Cardioangiol. 62 (1) (Feb 2014) 119–121.
165
[10] E. Imbalzano, M. Casale, M. D'Angelo, G. Mandraffino, V. Giugno, G. Di Bella, S. Carerj, G. Dattilo, Cardiovascular risk and psoriasis: a role in clinical cardiology? Angiology 66 (2) (Feb 2015) 101–103, http://dx.doi.org/10.1177/0003319714527339. [11] D. Tulino, E. Imbalzano, M. Casale, M. D'Angelo, S. Coglitore, G. Di Bella, G. Dattilo, Treatment failure of low molecular weight heparin in diabetic patient, Int. J. Cardiol. 168 (2) (Sep 30 2013) e63–e64, http://dx.doi.org/10.1016/j.ijcard.2013.07.064. [12] G. Dattilo, A. Lamari, S. Crosca, S. Tavella, P. Fugà, A. Conti, M. Scarano, P. Busacca, Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation, Recenti Prog. Med. 103 (9) (Sep 2012) 328–332, http:// dx.doi.org/10.1701/1136.12526. [13] A. Apostolo, P. Laveneziana, P. Palange, C. Agalbato, R. Molle, D. Popovic, M. Bussotti, M. Internullo, S. Sciomer, M. Bonini, M.C. Alencar, L. Godinas, F. Arbex, G. Garcia, J.A. Neder, P. Agostoni, Impact of chronic obstructive pulmonary disease on exercise ventilatory efficiency in heart failure, Int. J. Cardiol. 189 (Jun 15 2015) 134–140, http://dx.doi.org/10.1016/j.ijcard.2015.03.422. [14] E. Imbalzano, G. Di Bella, A. Lamari, M. Scarano, M. Casale, P. Busacca, S. Carerj, G. Dattilo, Right ventricular myocardial deformation in young healthy subjects: a comparison study between 2D Strain and traditional parameters, J. Exp. Clin. Cardiol. 20 (1) (2014) 2729–2743. [15] E. Imbalzano, A. Saitta, A. Lamari, G. Trapani, G. Lizio, M. Creazzo, G. Mandraffino, M. Scarano, G. Dattilo, Echo-Doppler evaluation of recent onset chronic venous insufficiency in elderly patients: does the heart have a role? Recenti Prog. Med. 104 (11) (Nov 2013) 569–573, http://dx.doi.org/10.1701/1370.15226. [16] G. Mandraffino, M.A. Sardo, S. Riggio, A. D'Ascola, S. Loddo, A. Alibrandi, C. Saitta, E. Imbalzano, R. Mandraffino, M. Venza, E.M. Mormina, A. David, A. Saitta, Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count, Clin. Biochem. 43 (18) (Dec 2010) 1436–1442, http://dx.doi. org/10.1016/j.clinbiochem.2010.09.023. [17] E. Durante-Mangoni, R. Andini, F. Agrusta, D. Iossa, I. Mattucci, M. Bernardo, R. Utili, Infective endocarditis due to multidrug resistant gram-negative bacilli: single centre experience over 5 years, Eur. J. Intern. Med. 25 (2014) 657–661. [18] R. Gaynes, J.R. Edwards, National Infections Surveillance System, Overview of nosocomial infections caused by Gram-negative bacilli, Clin. Infect. Dis. 41 (2005) 848–854. [19] I. Ikonomidis, G. Makavos, N. Nikitas, I. Paraskevaidis, A. Diamantakis, P. Kopterides, M. Theodorakopoulou, J. Parissis, J. Lekakis, A. Armaganidis, I. Dimopoulou, Coronary flow reserve is associated with tissue ischemia and is an additive predictor of intensive care unit mortality to traditional risk scores in septic shock, Int. J. Cardiol. 172 (1) (Mar 1 2014) 103–108. [20] N.J. Mehta, I.A. Khan, V. Gupta, K. Jani, R.M. Gowda, P.R. Smith, Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock, Int. J. Cardiol. 95 (1) (May 2004) 13–17.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Acinetobacter baumannii and cardiac impairment. Increasingly important nosocomial pathogen M. Tempesta a, A. Campanella b, S. Maviglia a,⁎ a b
Division of Anesthesiology and Intensive Care, Hospital San Salvatore, Pesaro, Italy Division of Cardiac Surgery, Hospital SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
a r t i c l e
i n f o
Article history: Received 4 June 2015 Accepted 20 June 2015 Available online 26 June 2015
Infective endocarditis (IE) is a bacterial infection of the endothelial surface of the heart. The incidence of IE varies according to the country from 3 to 10 cases per 100,000 persons/year. Streptococci, staphylococci, enterococci and coccobacilli Gram-negative are the cause of most of IE. In particular it is emerging as a new IE, the nosocomial endocarditis, as a result of new or more widespread therapeutic modalities: intravascular catheters, pacemakers, dialysis shunts, etc. [1–6]. We present a case report of a woman 56 years bearer of biological aortic prosthesis for aortic valve bicuspid stenosis and pacemaker DDDr for atrioventricular block. In his clinical history there was psoriasis, diabetes newly diagnosed, a history of chronic obstructive pulmonary bronchitis with chronic pulmonary heart disease and a history of being a former smoker [7–16].
The patient comes to the emergency room with severe respiratory failure so she was intubated and transferred to the intensive care unit where after about 15 days has persistent high fever. The physical examination showed a systolic murmur 2/6 L ubiquitous. The transesophageal echocardiogram showed a dehiscence of the aortic prosthesis with a small vegetation between the left coronary cusp and the right coronary cusp (Fig. 1) and blood cultures are positive for Acinetobacter baumannii [3–6]. A. baumannii is a gram-negative, non motile coccobacillus. It is widely distributed in the environment. Its ability to survive even in hostile conditions allows it to a wide circulation in the hospital setting, where it is to date the most fearsome germ responsible for nosocomial infections [17–20]. The relevance of this case is focused on the fact that IE sustained by the fearsome coccobacillus A. baumannii is not a frequent but always a possible cause of nosocomial infective endocarditis. Attention should be paid to the asepsis procedures of the intensive care unit.
Conflict of interest The authors report no relationships that could be construed as a conflict of interest.
Fig. 1. Transesophageal echocardiography. Panels A and B: dehiscence of the aortic prosthesis with insufficiency transvalvular moderate. Panel C: small vegetation between the left coronary cusp and the right coronary cusp. ⁎ Corresponding author at: Unità operativa di Anestesia e Rianimazione, Ospedale San Salvatore, Piazzale Cinelli 4, 61121 Pesaro, PU, Italia. Tel.: +39 3407635966. E-mail address: [email protected] (S. Maviglia).
http://dx.doi.org/10.1016/j.ijcard.2015.06.085 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
Letter to the Editor
Acknowledgments The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology References [1] F. Delahaye, V.H. Chu, J. Altclas, B. Barsic, A. Delahaye, T. Freiberger, D.L. Gordon, M.M. Hannan, B. Hoen, S.S. Kanj, T. Lejko-Zupanc, C.A. Mestres, O. Pachirat, P. Pappas, C. Lamas, C. Selton-Suty, R. Tan, P. Tattevin, A. Wang, International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) Investigators, One-year outcome following biological or mechanical valve replacement for infective endocarditis, Int. J. Cardiol. 178 (Jan 15 2015) 117–123, http://dx.doi.org/10. 1016/j.ijcard.2014.10.125. [2] M. Mirabel, R. André, P. Barsoum, H. Colboc, F. Lacassin, B. Noel, O. Axler, G. Phelippeau, C. Braunstein, E. Marijon, B. Iung, X. Jouven, Ethnic disparities in the incidence of infective endocarditis in the Pacific, Int. J. Cardiol. 186 (Mar 18 2015) 43–44, http://dx.doi.org/10.1016/j.ijcard.2015.03.243. [3] N. Martins, I.S. Martins, W.V. de Freitas, J.A. de Matos, A.C.G. Magalhães, V.B.C. Girão, R.C.S. Dias, T.C. de Souza, F.L.P.C. Pellegrino, L.D. Costa, C.H.R. Boasquevisque, S.A. Nouér, L.W. Riley, G. Santoro-Lopes, B.M. Moreira, Severe infection in a lung transplant recipient caused by donor transmitted carbapenem-resistant Acinetobacter baumannii, Transpl. Infect. Dis. 14 (3) (June 2012) 316–320. [4] C. Zhao, W. Xie, W. Zhang, Z. Ye, H. Wu, Mechanism of drug resistance of carbapenems-resistant Acinetobacter baumannii and the application of a combination of drugs in vitro, Zhonghua Shao Shang Za Zhi 30 (2) (Apr 2014) 166–170. [5] M.E. Falagas, P. Kopterides, Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature, J. Hosp. Infect. 64 (2006) 7–15. [6] P. Laganà, L. Melcarne, S. Delia, Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance, Int. J. Cardiol. 187 (May 6 2015) 678–679, http://dx.doi.org/10.1016/j.ijcard.2015.04.019. [7] G. Dattilo, M. Scarano, M. Casale, M. Sergi, S. Quattrocchi, M. Parato, E. Imbalzano, An atypical manifestation of Twiddler syndrome, Int. J. Cardiol. 186 (May 1 2015) 1–2, http://dx.doi.org/10.1016/j.ijcard.2015.03.184. [8] G. Dattilo, A. Lamari, V. Tulino, M. Scarano, E. De Luca, D. Mutone, P. Busacca, Congenital valvular heart disease with high familial penetrance, Recenti Prog. Med. 103 (12) (Dec 2012) 581–583, http://dx.doi.org/10.1701/1206.13361. [9] G. Dattilo, A. Lamari, M. Scarano, G. Di Bella, E. Imbalzano, P. Busacca, S. Coglitore, Coronary artery disease and psoriasis, Minerva Cardioangiol. 62 (1) (Feb 2014) 119–121.
165
[10] E. Imbalzano, M. Casale, M. D'Angelo, G. Mandraffino, V. Giugno, G. Di Bella, S. Carerj, G. Dattilo, Cardiovascular risk and psoriasis: a role in clinical cardiology? Angiology 66 (2) (Feb 2015) 101–103, http://dx.doi.org/10.1177/0003319714527339. [11] D. Tulino, E. Imbalzano, M. Casale, M. D'Angelo, S. Coglitore, G. Di Bella, G. Dattilo, Treatment failure of low molecular weight heparin in diabetic patient, Int. J. Cardiol. 168 (2) (Sep 30 2013) e63–e64, http://dx.doi.org/10.1016/j.ijcard.2013.07.064. [12] G. Dattilo, A. Lamari, S. Crosca, S. Tavella, P. Fugà, A. Conti, M. Scarano, P. Busacca, Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation, Recenti Prog. Med. 103 (9) (Sep 2012) 328–332, http:// dx.doi.org/10.1701/1136.12526. [13] A. Apostolo, P. Laveneziana, P. Palange, C. Agalbato, R. Molle, D. Popovic, M. Bussotti, M. Internullo, S. Sciomer, M. Bonini, M.C. Alencar, L. Godinas, F. Arbex, G. Garcia, J.A. Neder, P. Agostoni, Impact of chronic obstructive pulmonary disease on exercise ventilatory efficiency in heart failure, Int. J. Cardiol. 189 (Jun 15 2015) 134–140, http://dx.doi.org/10.1016/j.ijcard.2015.03.422. [14] E. Imbalzano, G. Di Bella, A. Lamari, M. Scarano, M. Casale, P. Busacca, S. Carerj, G. Dattilo, Right ventricular myocardial deformation in young healthy subjects: a comparison study between 2D Strain and traditional parameters, J. Exp. Clin. Cardiol. 20 (1) (2014) 2729–2743. [15] E. Imbalzano, A. Saitta, A. Lamari, G. Trapani, G. Lizio, M. Creazzo, G. Mandraffino, M. Scarano, G. Dattilo, Echo-Doppler evaluation of recent onset chronic venous insufficiency in elderly patients: does the heart have a role? Recenti Prog. Med. 104 (11) (Nov 2013) 569–573, http://dx.doi.org/10.1701/1370.15226. [16] G. Mandraffino, M.A. Sardo, S. Riggio, A. D'Ascola, S. Loddo, A. Alibrandi, C. Saitta, E. Imbalzano, R. Mandraffino, M. Venza, E.M. Mormina, A. David, A. Saitta, Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count, Clin. Biochem. 43 (18) (Dec 2010) 1436–1442, http://dx.doi. org/10.1016/j.clinbiochem.2010.09.023. [17] E. Durante-Mangoni, R. Andini, F. Agrusta, D. Iossa, I. Mattucci, M. Bernardo, R. Utili, Infective endocarditis due to multidrug resistant gram-negative bacilli: single centre experience over 5 years, Eur. J. Intern. Med. 25 (2014) 657–661. [18] R. Gaynes, J.R. Edwards, National Infections Surveillance System, Overview of nosocomial infections caused by Gram-negative bacilli, Clin. Infect. Dis. 41 (2005) 848–854. [19] I. Ikonomidis, G. Makavos, N. Nikitas, I. Paraskevaidis, A. Diamantakis, P. Kopterides, M. Theodorakopoulou, J. Parissis, J. Lekakis, A. Armaganidis, I. Dimopoulou, Coronary flow reserve is associated with tissue ischemia and is an additive predictor of intensive care unit mortality to traditional risk scores in septic shock, Int. J. Cardiol. 172 (1) (Mar 1 2014) 103–108. [20] N.J. Mehta, I.A. Khan, V. Gupta, K. Jani, R.M. Gowda, P.R. Smith, Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock, Int. J. Cardiol. 95 (1) (May 2004) 13–17.
