Case Study

Infective endocarditis (IE) is a rare but life-threatening cardiac condition. Healthcare-associated infective endocarditis (HAIE) is an emerging subtype that occurs more than 48 hours after hospital admission, often following invasive procedures. Its occurrence in patients with end-stage kidney disease (ESKD) is not uncommon. Prosthetic valve endocarditis may also be healthcare-associated (HA-PVE) when it develops within one year of valve replacement. Antimicrobial-resistant Staphylococcus species are increasingly implicated in both forms. Amidst a paucity of data on HAIE in Nigeria, we report a case series involving both native valve HAIE in ESKD patients and prosthetic valve HAIE (HA-PVE). These cases were identified over one year in a 150-bed private tertiary healthcare institution in Southwest Nigeria. Patients were diagnosed based on the modified Duke’s criteria. HAIE was attributed to central-line cannulation in ESKD patients, while HA-PVE occurred within a year of valve surgery. Methicillin-resistant Staphylococcus species were the causative pathogens. Elevated erythrocyte sedimentation rates and neutrophilia were consistent findings. This study emphasizes the importance of early and thorough cardiovascular evaluation in ESKD patients with central-line access to facilitate early IE detection. Hemogram and sepsis biomarkers may serve as adjuncts to blood culture in confirming diagnosis. Glycopeptide antibiotics should be considered as first-line empirical therapy. Healthcare-associated IE involving native and prosthetic valves can present with diverse symptoms. The aforementioned diagnostic and management strategies are particularly relevant in resource-limited settings.

Elderly patients with frailty and multiple comorbidities increasingly require mitral valve surgery. This includes patients who have previously undergone surgery with a tissue valve, which may deteriorate over time and require replacement. These cases are considered high-risk. There is growing interest in performing valve replacements using minimally invasive techniques, including access via the groin. However, such approaches are not always feasible. Here, we report the first case where innovative, "outside-the-box" thinking was employed to replace the valve using a non-conventional approach.