NATIVE AND PROSTHETIC VALVE ENDOCARDITIS CAUSED BY ROTHIA-DENTOCARIOSA - DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS

Three cases, one each of native valve, prosthetic valve and composite graft endocarditis caused by Rothia dentocariosa are described. The fi rst patient presented with multiple brain abscesses and severe congest ive heart failure due to destructive endocarditis with large vegetatio ns on the mitral valve, He died shortly after emergency valve replacem ent. Gram-positive coccoid rods were identified in the vegetations of the excised mitral valve. The second patient had a R. dentocariosa end ocarditis of a prosthetic aortic valve that was treated empirically wi th netilmicin and teicoplanin, due to an allergy to penicillin. Both a ntibiotics were replaced according to susceptibility testing in vitro with rifampin and ciprofloxacin, and the endocarditis was cured within 9 weeks. The third patient presented with a circular root abscess of an aortic composite graft that was successfully treated with rifampin and ceftriaxone without surgery. All patients had extensive periodonta l disease which was thought to be responsible for hematogenic spread a nd seeding of the microorganism. The microbiological identification an d antibiotic resistance pattern of the isolates, as well as therapeuti c implications are discussed.