Levofloxacin-Resistant Streptococcus gordonii Infective Endocarditis in an Elderly Patient: A Case Report
Abstract
Infective endocarditis (IE) in older adults often presents with nonspecific or subtle clinical features, which may delay recognition, especially when antibiotics are initiated before appropriate diagnostic testing. Streptococcus gordonii is a common oral organism capable of causing IE. We describe a case of IE caused by levofloxacin-resistant S. gordonii in a woman in her 90s with poor oral hygiene. She developed persistent fever after receiving empirical levofloxacin for a presumed urinary tract infection. Although recent dental procedures were absent, blood cultures obtained prior to hospital admission yielded S. gordonii. Transthoracic echocardiography revealed severe aortic regurgitation without vegetations, while brain magnetic resonance imaging demonstrated multiple embolic infarctions. The diagnosis of IE was based on the isolation of S. gordonii and clinical features consistent with the disease, including fever, severe aortic regurgitation, multiple cerebral embolic infarctions, and glomerulonephritis. The organism was resistant to levofloxacin while remaining susceptible to penicillin and ceftriaxone. Despite administration of appropriate antimicrobial therapy, the patient's condition deteriorated, and palliative care was pursued in accordance with her wishes. This case underscores two critical diagnostic and management challenges in IE among older adult patients: failure to obtain blood cultures before initiating antibiotics and the potential contribution of poor…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.