We report an unusual case of endocarditis occurring in a 74-year-old man with a history of systemic hypertension, diabetes mellitus and minor amputation for left forefoot ulcer. The patient was hospitalized for vacuum-assisted closure therapy to aid in wound healing. After the first treatment session, the patient reported abdominal pain with haematemesis and fever (40 °C). Owing to persistent fever, three blood cultures were performed, all positive for Kocuria kristinae. The identification was based on biochemical tests and automated systems. The speciation of the micro-organism was achieved with MALDI-TOF and then confirmed by 16S rRNA gene sequencing. Transthoracic echocardiographic examination showed the presence of a large vegetation (38×20 mm) on the posterior mitral leaflet and moderate mitral regurgitation. Since there are no current guidelines for the treatment of K. kristinae endocarditis, empiric antibiotic therapy with intravenous sulbactam/ampicillin (1.5 g twice daily) and gentamicin (6 mg kg−1 per day) was started. After 7 days of hospitalization, the patient’s condition suddenly worsened because of the occurrence of haemorrhagic stroke. Despite inotropic support and rifampicin infusion, the haemodynamic status progressively deteriorated. After an initial improvement, he worsened again, becoming stuporous, hypotensive and dyspnoeic. In the following days, the patient developed compartment syndrome resulting in right foot ischaemia. Unfortunately, 25 days after hospitalization, the patient died of multiple organ failure from overwhelming sepsis. To the best of our knowledge, this is the first case of K. kristinae endocarditis on a native valve that is not related to a central venous catheter but associated with diabetic foot infection.
BasagliaG., CarrettoE., BarbariniD., MorasL., ScaloneS., MaroneP., De PaoliP.2002; Catheter-related bacteremia due to Kocuria kristinae in a patient with ovarian cancer. J Clin Microbiol 40:311–313 [View Article][PubMed]
DunnR., BaresS., DavidM. Z.2011; Central venous catheter-related bacteremia caused by Kocuria kristinae: case report and review of the literature. Ann Clin Microbiol Antimicrob 10:31 [View Article][PubMed]
MaE. S. K., WongC. L. P., LaiK. T. W., ChanE. C. H., YamW. C., ChanA. C. W.2005; Kocuria kristinae infection associated with acute cholecystitis. BMC Infect Dis 5:60 [View Article][PubMed]
MartinaudC., GisserotO., GaillardT., BrisouP., de JaureguiberryJ. P.2008; [Bactériémie à Kocuria kristinae au cours d’une leucémie aiguë]. Med Mal Infect 38:334–335 (in French) [PubMed]
OncelE. K., BoyrazM. S., KaraA.2012; Black tongue associated with Kocuria (Micrococcus) kristinae bacteremia in a 4-month-old infant. Eur J Pediatr 171:593 [View Article][PubMed]
StackebrandtE., KochC., GvozdiakO., SchumannP.1995; Taxonomic dissection of the genus Micrococcus: Kocuria gen. nov., Nesterenkonia gen. nov., Kytococcus gen. nov., Dermacoccus gen. nov., and Micrococcus Cohn 1872 gen. emend. Int J Syst Bacteriol 45:682–692 [View Article][PubMed]