'TAVR Infected Pseudomonas Endocarditis': a case report.

This suggested that his infection had not been cleared the first time and most likely he had a source of bacterial growth. A few years prior, a transcatheter aortic valve replacement (TAVR) had been performed for the patient. This was suspected as the source of continued infection and so a transthoracic echocardiogram was obtained, which revealed vegetation on the TAVR. We also obtained a magnetic resonance imaging (MRI) of the brain, which demonstrated infarcts of several portions of the brain consistent with emboli. Due to his age and additional medical issues, the patient was not a candidate for surgical valve replacement. We decided to try medical therapy with a fluoroquinolone antibiotic since the bacteria was susceptible to it. Unfortunately, he had demonstrated allergies to the usual choices to include Levaquin and ciprofloxacin. Therefore, we elected to start him on a new fluoroquinolone agent that had recently been FDA approved and obtained by our facility called delafloxacin. The patient tolerated this well and his repeat blood cultures remain clear. After discussion with the infectious disease specialist, he requires a lifelong suppression with the medication since the TAVR cannot be removed. This case is meant to illustrate the effectiveness of medical therapy when surgical options are not available.