What is the optimal management approach for a 78-year-old male patient with Human Immunodeficiency Virus (HIV) infection, Coronary Artery Disease (CAD) status post Coronary Artery Bypass Grafting (CABG) and Aortic Valve Replacement (AVR) with a bioprosthetic valve, Parkinson's disease, and recent spine surgery, who presents with fever, chills, and overflow incontinence, and is found to have Enterococcus faecium in urine culture, with echocardiogram showing vegetations on the native mitral valve?

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From the Guidelines

The optimal management approach for this patient is to treat the Enterococcus faecium infection as a case of infective endocarditis, given the presence of vegetations on the native mitral valve, and to start empirical antibiotic therapy promptly, as recommended by the 2015 ESC guidelines for the management of infective endocarditis 1.

Immediate Management

For immediate management, switch to daptomycin at a dose of 8-12 mg/kg daily, as recommended by the 2022 guidelines for the treatment of infections due to multidrug-resistant organisms 1, plus ampicillin-sulbactam, while awaiting blood culture results. The dosing for daptomycin should be adjusted based on renal function and therapeutic drug monitoring.

Diagnostic Evaluation

A PET-CT scan is warranted to evaluate for cardiac device infection involving the PPI leads, as this would significantly impact management decisions, potentially requiring device extraction if infected, as recommended by the 2020 ACC/AHA guideline for the management of patients with valvular heart disease 1.

Treatment Duration

Treatment duration should be at least 6 weeks given the prosthetic material, as recommended by the 2015 ESC guidelines for the management of infective endocarditis 1. Surgical evaluation is also recommended given the large vegetation size, which carries embolic risk. Regular echocardiographic monitoring is essential to assess treatment response and vegetation evolution.

Key Considerations

  • The patient's immunocompromised status and previous bacteremia increase the risk of complications and require close monitoring.
  • The presence of Enterococcus faecium in the urine culture, despite not being the most common cause of endocarditis, warrants full treatment for endocarditis due to the patient's clinical presentation and immunocompromised status.
  • The use of daptomycin, as recommended by the 2022 guidelines for the treatment of infections due to multidrug-resistant organisms 1, is preferred due to its bactericidal activity against Enterococcus faecium.

From the Research

Patient Profile

  • 78-year-old male patient with multiple comorbidities:
    • Human Immunodeficiency Virus (HIV) infection
    • Coronary Artery Disease (CAD) status post Coronary Artery Bypass Grafting (CABG)
    • Aortic Valve Replacement (AVR) with a bioprosthetic valve
    • Parkinson's disease
    • Recent spine surgery
  • Presents with fever, chills, and overflow incontinence
  • Urine culture shows Enterococcus faecium
  • Echocardiogram reveals vegetations on the native mitral valve

Management Approach

  • The patient's condition is complex, with multiple comorbidities and a rare infection caused by Enterococcus faecium 2, 3, 4
  • Optimal antimicrobial therapy remains undefined, but an attempt to identify bactericidal combination therapy should be sought 4
  • Treatment options may include:
    • Ampicillin and gentamicin for 8 weeks 2
    • Chloramphenicol plus minocycline for 8 weeks 3
    • Quinupristin-dalfopristin 3
  • Surgical intervention may be necessary, especially if the patient develops cardiac complications or if the infection is not responding to antimicrobial therapy 4, 5
  • A multidisciplinary approach is crucial for optimal patient outcomes, involving cardiologists, infectious disease specialists, and surgeons 5

Considerations

  • The patient's HIV status and immunocompromised state may affect the treatment approach and outcome
  • The presence of a bioprosthetic valve and recent spine surgery may increase the risk of complications and affect the treatment plan
  • The patient's age and underlying medical conditions may impact the decision to pursue surgical intervention 4, 5

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Prosthetic valve endocarditis due to vancomycin-resistant Enterococcus faecium: treatment with chloramphenicol plus minocycline.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2002

Research

Endocarditis due to vancomycin-resistant enterococci: case report and review of the literature.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2005

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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