Recurrent Bacteremia in the Setting of Pseudomonas Endocarditis of the Tricuspid Valve and Indwelling Medical Devices

This case report presents a complex and challenging scenario of recurrent <i>Pseudomonas aeruginosa</i> (<i>P. aeruginosa</i>) bacteremia and tricuspid valve endocarditis in a 77-year-old male patient with multiple comorbidities and indwelling medical devices. The patient's medical history was significant for T4 paraplegia, neurogenic bladder requiring a chronic indwelling suprapubic catheter, heart block status post-permanent pacemaker placement, type 2 diabetes mellitus, chronic kidney disease, and chronic sacral wounds. The case highlights the difficulties in managing antibiotic-resistant <i>P. aeruginosa</i> infections, particularly in patients with implantable devices and chronic wounds. The patient's clinical course was marked by multiple hospital admissions, each time presenting with fever, confusion, and positive blood cultures for <i>P. aeruginosa</i>. Despite aggressive antibiotic treatment and interventions such as pacemaker replacement and tricuspid valve debulking, the patient's condition continued to deteriorate. The recurring nature of the infection, despite therapeutic interventions, underscores the risk of bacterial seeding of indwelling medical devices and the challenges posed by antibiotic resistance. This case also draws attention to the significance of <i>P. aeruginosa</i> as a causative agent of severe nosocomial infections, particularly in immunocompromised individuals, and its growing resistance to antibiotics through mechanisms such as biofilm formation. Ultimately, the patient developed septic shock and transitioned to comfort care due to treatment failure, highlighting the difficult clinical decisions required in the face of chronic infections refractory to repeated interventions. This case serves as a reminder of the need for continued vigilance and innovative strategies, such as multifunctional antibacterial-coated devices, in preventing and managing device-associated infections. This is particularly important in the context of increasing antibiotic resistance and the complications associated with biofilm formation.