Infective endocarditis of the aortic valve in an 85-year-old man due to translocation of the intestinal flora

Abstract

Infective endocarditis (IE) is an infectious and inflammatory disease of the endocardium that is associated with a high incidence of complications and mortality. Elderly patients are the most vulnerable age group for the IE. Infective endocarditis caused by E. coli is a rare disease due to both bacteria life-cycle and human immune system protection. Nevertheless, recent years the incidence of IE associated with E. coli has been increasing in the group of elderly patients. It seems important to reassess the indications for antibiotic prophylaxis in certain categories of patients (including the elderly patients with an unobvious but increased risk of IE). This clinical case demonstrates a native valve endocarditis caused by E. coli developed after bowel preparation with osmotic laxatives and endoscopic procedure in an 85 year-old male without significant chronic diseases. Despite the fact that the patient did not belong to the category of increased risk of IE, he had the predisposing conditions for the development of IE (weaked immune system, bacteremia, heart valve sclerosis), that realized in the active manifest disease. Treatment with antibiotics led to an improvement in the patient’s condition and regression of infectious vegetations on the valve. Repeat blood cultures were negative. When planning endoscopic procedure for patients at risks (elderly person, weakened immune system, minimal aortic valve lesions), antibacterial prophylaxis should be considered. Additional research is required to develop clear algorithms for antibacterial prophylaxis.