Successful three-year levofloxacin treatment for recurrent non-typhoidal Salmonella bacteremia in a patient with a bioprosthetic valve

Although uncommon, non-typhoidal <i>Salmonella</i> bacteremia is clinically challenging, especially in patients with prosthetic material. Infective endocarditis can occur as a complication of non-typhoidal <i>Salmonella</i> bacteremia, and management typically involves a six-week course of antibiotics in conjunction with surgery. However, the optimal management for patients with retained prosthetic material in the absence of a clear infectious focus remains uncertain. We report a case of recurrent non-typhoidal <i>Salmonella</i> bacteremia in a patient with a bioprosthetic valve. Imaging studies revealed no identifiable infectious focus. Initial two episodes were treated with ceftriaxone; the third was managed with levofloxacin and rifampin, followed by three years of levofloxacin. The patient was cured without surgery. This case highlights the therapeutic challenges of managing non-typhoidal <i>Salmonella</i> bacteremia in the presence of prosthetic material. In cases where extensive imaging studies reveal no infectious focus, long-term antimicrobial therapy without surgical intervention may be a feasible approach, provided that persistent negativity of blood cultures and clinical stability are achieved. Such cases may also enable clinicians to determine the appropriate timing of discontinuing long-term oral antimicrobial therapy.