The novel use of oral antibiotic monotherapy in prosthetic valve endocarditis caused by Finegoldia magna: a case study.
BACKGROUND
Finegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature. Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis.


CASE PRESENTATION
This case report focuses on a 52-year-old gentleman, who presented with initially culture-negative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up.


CONCLUSIONS
This case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery.
['Chien|Siobhan|S|http://orcid.org/0000-0001-9657-193X', 'Gorman|David|D|', 'Koutsogiannidis|Charilaos-Panagiotis|CP|', 'Ravishankar|Ramanish|R|', 'Kamath|Ganesh|G|', 'Zamvar|Vipin|V|']
D000284:Administration, Oral D000900:Anti-Bacterial Agents D001021:Aortic Valve D001705:Bioprosthesis D004697:Endocarditis, Bacterial D000068536:Firmicutes D016908:Gram-Positive Bacterial Infections D006350:Heart Valve Prosthesis D006801:Humans D008297:Male D008826:Microbial Sensitivity Tests D008875:Middle Aged D016459:Prosthesis-Related Infections
Oral antibiotics Prosthetic valve endocarditis Finegoldia magna Infective endocarditis Administration Cardiac surgical procedures Treatment outcome