RESUMO
Eustachian valve endocarditis caused by Actinomyces species is extremely rare. A literature review revealed only one reported case-caused by Actinomyces israelii in an intravenous drug abuser. Our patient, a 30-year-old woman who at first appeared to be in good health, presented with fever, a large mobile mass on the eustachian valve, and extensive intra-abdominal and pelvic masses that looked malignant. Histopathologic examination of tissue found in association with an intrauterine contraceptive device revealed filamentous, branching microorganisms consistent with Actinomyces turicensis. This patient was treated successfully with antibiotic agents. In addition to presenting a new case of a rare condition, we discuss cardiac actinomycotic infections in general and eustachian valve endocarditis in particular: its predisposing factors, clinical course, sequelae, and our approaches to its management.
Assuntos
Actinomicose/microbiologia , Endocardite Bacteriana/microbiologia , Valvas Cardíacas/microbiologia , Dispositivos Intrauterinos/microbiologia , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Biópsia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Valvas Cardíacas/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the impact that a formalized de-escalation protocol to ertapenem could potentially have on group 2 carbapenem usage in the hope of alleviating the selective pressure on Acinetobacter and Pseudomonas. This analysis was conducted in three hospitals within the Detroit Medical Center in 2009. Patients were considered candidates for de-escalation of carbapenem therapy when a group 2 carbapenem was utilized to treat Enterobacteriaceae, such as extended spectrum ß-lactamase (ESBL)-producing organisms, or if cultures were negative in non-intensive care unit (ICU) patients. In total, 179 patients (28%) and 1074 patient-days (29%) were deemed eligible for de-escalation according to our pre-defined criteria. We concluded that preferential utilization of ertapenem in appropriate patients warranting carbapenem therapy has the potential to significantly decrease group 2 carbapenem usage at our institution.
