Medical management of Pseudomonas aeruginosa endocarditis: A case report

Background: Pseudomonas aeruginosa is a rare cause of infective endocarditis. There is no standard treatment regimen for the management of infective endocarditis caused by this organism. Pseudomonas aeruginosa produces biofilm on the endocardial surface which can be difficult to eradicate, and monotherapy with a traditional beta-lactam agent may fail due to inadequate penetration into biofilm and low or absent activity on non-dividing cells. Prolonged courses and surgical intervention may be required to treat this infection. Case Description: A case of infective endocarditis caused by P. aeruginosa which showed inadequate response to beta-lactam plus beta-lactamase-inhibitor therapy and was later successfully managed without surgical intervention but a combination of a beta-lactam and an aminoglycoside is described here. This case which was treated with amikacin was followed up for ototoxicity. Ototoxicity is an irreversible side effect of amikacin and close follow-up with serial audiograms is required during therapy, especially when therapeutic drug monitoring is not possible. Conclusion: A combination regimen of a beta-lactam active against P. aeruginosa plus an aminoglycoside for a duration of four weeks can be an effective treatment for infective endocarditis caused by P. aeruginosa. Periodic monitoring for adverse drug events should be undertaken during therapy.