Indiana University Infectious Diseases Fellowship
29 Jan,
9 tweets, 5 min read
#IdBoardReview 60 F cirrhosis, aortic regurgitation, previous hx cdiff on probiotics presents w/ new onset heart failure. Blood culture Gram+bacilli with vancomycin resistance. Diagnosis? #medEd #idmedEd #IDtwitter 
Probiotic associated #Lactobacillus rhamnosus #endocarditis
#Lactobacillus, GI & GU flora commensal, can cause invasive infections such as meningitis, endometritis, peritonitis, pneumonia, bacteraemia and endocarditis. It has been implicated as a causative agent in 0.05-0.4% of all #endocarditis
#lactobacillus #endocarditis rare. R.f. underlying structural heart disease or dental abnormalities or probiotic consumption
Many strains of #Lactobacillus including L. rhamnosus are intrinsically resistant to vancomycin; resistance to ciprofloxacin, tetracycline, meropenem, metronidazole and sulphonamides has been reported, with some isolates exhibiting intermediate resistance to linezolid
commonly recommended treatment for #lactobacillus infective endocarditis is synergistic therapy penicillin plus gent
presence of #lactobacillus in blood culture should not be routinely considered as a contaminant and careful evaluation of patient clinical status & diet/probiotic should be explored. immunosuppressed pts should be cautious before using probiotics w/ live or lyophilized organism
#probiotic associated infections …plementmedtherapies.biomedcentral.com/articles/10.11…
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