Stenotrophomonas maltophilia endocarditis after mitral valvuloplasty. A case report

The authors report the first case of early postoperative endocarditis after mitral valvuloplasty due to Stenotrophomonas Maltophilia, a Gram negative organism, in a 37 year old man with no special risk factors. Pyrexia and mitral valve vegetations were the main features, and, in the ab sence of complications or of embolism, the patient was treated initially wi th triple antibiotherapy (ceftazidime, amikacine, ciprofloxacine). Relapse two weeks after withdrawal of treatment due to two variants of Sten otrophomas Maltophilia, one of which was resistant to ciprofloxacine, and t he presence of a large vegetation, required repeat mitral valvuloplasty and a change in antibiotic therapy (ticarcilline with clavulanic acid, trimeth oprim sulphamethoxazole, colistine). This time, the outcome was good. The little known Stenotrophomonas Maltophilia infectious endocarditis is a serious complication and, in the absence of standardised management, the au thors suggest that, in view of the multi-resistant character of the organis m and in the light of this case, surgery should be considered in associatio n with prolonged antibiotic therapy.