Successful treatment of Candida parapsilosis and Pseudomonas aeruginosa infection using medical and surgical management in an injecting drug user with mitral and aortic valve endocarditis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Polymicrobial endocarditis is a well-recognized problem in intravenous drug users and it accounts for 1 to 3% of endocarditis cases overall and up to 9% in other series. The most common combinations of organisms include <it>Staphylococcus aureus</it> and <it>Streptococcus pneumoniae</it> followed by <it>Staphylococcus aureus</it> and <it>Pseudomonas aeruginosa</it>. <it>Candida parapsilosis</it> endocarditis carries a mortality rate of 45%, and each infection with <it>Candida</it> or <it>Pseudomonas</it> endocarditis per se carries a very high mortality rate approaching 85% and 80%, respectively. The combination of <it>P. aeruginosa</it> and <it>C. parapsilosis</it> has never been encountered and there have been no earlier reports of the combination of <it>C. parapsilosis</it> and <it>P. aeruginosa</it> in adult intravenous drug users as a cause of endocarditis.</p> <p>Case presentation</p> <p>We present a 49-year-old man with bivalvular endocarditis with <it>P. aeruginosa</it> and <it>C. parapsilosis</it>. He had a prior bivalvular replacement in 2005 that became infected with the above microorganisms and he was treated with intravenous antibiotics. Because of ongoing intravenous drug use, a second valve replacement was denied. A few days later, the patient presented with septic shock secondary to <it>P. aeruginosa</it> and <it>C. parapsilosis</it> recurrent endocarditis. The infection was cured with a second bivalvular replacement and extended therapy with antibiotics and antifungals.</p> <p>Conclusion</p> <p>This is the first time a patient has presented with <it>P. aeruginosa</it> and <it>C. parapsilosis endocarditis</it>. Relapsing polymicrobial endocarditis can be cured with medical and surgical therapy.</p