(174) Staphylococcus capitis Native Valve Endocarditis Presenting With Cardiac Arrest

Introduction: Coagulase-negative staphylococci (CoNS) account for 5% of native-valve endocarditis (NVE) (1). Staphylococcus capitis, a species of CoNS, is a rare cause of infective endocarditis (IE), with fewer than 15 cases reported to date (2). Catheter-related infections are common among patients who require chronic hemodialysis (HD). Despite advances in anti-infective protocols, innovative catheter designs, and implementation of national guidelines, central venous catheters remain a major source of serious mortality and morbidity in HD patients (3).

Description: A 62-year-old male was admitted for shortness of breath and subjective fevers. Shortly after the initial evaluation, the EKG revealed complete heart block and he experienced a sudden episode of pulseless electrical activity. Initial and repeated sets of blood cultures isolated Staphylococcus capitis, prompting antibiotic treatment with vancomycin. The source of bacteremia was identified as a right internal jugular tunneled dialysis catheter, which was subsequently removed and replaced with a temporary femoral catheter. A transesophageal echocardiogram revealed vegetation on the left coronary cusp of the aortic valve, accompanied by severe aortic valve regurgitation, mild mitral regurgitation, and a flail mitral leaflet. Computed tomography angiography demonstrated prolapsed left coronary cusp leaflets. Left heart catheterization confirmed angiographically normal coronary arteries and severe aortic insufficiency. Ultimately, the decision was made to manage the patient surgically. Gram staining of the native aortic valve and culture of the aortic valve returned negative results, as did two separate repeat blood cultures. The patient completed antibiotic treatment and was eventually discharged.

Discussion: S. capitis NVE is a rare and underreported condition in the literature (2,4,5,6). CoNs are emerging as a significant cause of NVE in both community and healthcare setting (1). This case highlights the importance of early recognition of S. Capitis as a possible causative bacterium of endocarditis in native valves. Furthermore, it underscores the need for optimal combination of strategies for minimizing bacteremia and promoting infection prophylaxis for patients with tunneled catheters, which are currently not well defined (3).