Background

Infective endocarditis (IE) is a condition caused by microorganisms colonizing the endocardium, leading to proliferative or erosive lesions of the heart valves and other cardiac structures. The main characteristic of this disease is that bacteria colonizing the valvular vegetations are resistant to standard antibiotic therapy. Long-term parenteral therapy is needed to achieve high levels of bactericidal agents in the serum, which may not be feasible for dogs. A peripherally inserted central catheter (PICC) line is a long intravenous (IV) catheter that can be passed from a peripheral insertion site to a central vessel. This may facilitate blood sample collections and long-term intravenous treatment.

Case Presentation

An 11-year-old, male, intact, 35-kg Weimaraner was presented with quadriparesis, depression and anorexia. Laboratory test results revealed neutrophilia, mild azotemia, hypoalbuminemia, hyperbilirubinemia and high C-reactive protein concentration. Echocardiography revealed severe mitral valve regurgitation due to a large pedunculated vegetation on the lateral mitral valve (MV) leaflet. Blood culture was positive for Pasteurella multocida; the dog was initially treated with IV amoxicillin-clavulanate and enrofloxacin but deteriorated clinically and the antimicrobial treatment was changed to IV imipenem. After two weeks of hospitalization and treatment with IV antibiotics, the dog was discharged with a PICC line that was inserted into the lateral saphenous vein reaching the caudal vena cava. A single lumen line was placed via a peel-away catheter technique; following the insertion, a lateral radiograph was taken to confirm the catheter placement in the caudal vena cava. The dog was treated with IV broad-spectrum antibiotics for 2 months at home by his owners. There was a significant improvement in the dog’s clinical condition. A repeated echocardiography revealed no vegetations on the MV and repeated blood cultures were negative.

New/Unique Information

This is the first report describing the successful use of a PICC line for long-term outpatient IV antibiotic treatment of infective endocarditis.

E-mail: maria.elkin@mail.huji.ac.il