Hemodialysis-Associated Bacteremia Resulting in Trans catheter Aortic Valve Replacement Endocarditis

An 80-year-old female with history of end stage renal disease on hemodialysis and a transcatheter aortic valve replacement (TAVR) eight months prior was transferred to our facility for treatment of acute embolic right lower extremity ischemia. A transesophageal echocardiogram performed to evaluate for the source of emboli demonstrated large mobile vegetation on the aortic valve prosthesis. Blood cultures isolated methicillin-susceptible Staphylococcus aureus. Multiple complications developed, including small cerebral infarcts contributing to acute encephalopathy, acute liver failure secondary to rifampin therapy, and coagulopathy with multiple episodes of bleeding. She was discharged to a rehabilitation facility to complete a six-week course of cefazolin followed by lifelong oral antibiotic suppression therapy with cephalexin. She ultimately required below-the knee amputation of the ischemic limb.