Use of antibiotic loaded absorbable calcium beads in the treatment of infective endocarditis: A case report

Infective endocarditis in drug-addicted patients is a clinical condition affected by high morbidity and mortality. Valvular lesions are often destructive and can lead to cardiogenic shock for which urgent surgery is necessary before an adequate period of antibiotic therapy. Here we report the case of a 49-year-old man known for drug abuse and referred for urgent surgery due to aortic endocarditis associated with an aortic root abscess. The patient underwent aortic valve replacement. The aortic abscess was excluded using a heterologous pericardial patch after filling with an antimicrobial carrier based on a matrix of calcium sulfate (Stimulan®; Biocomposites Ltd., Keele, UK). The patient had an uneventful postoperative course and recovered well at 6-month follow-up. To our knowledge, this is the first report demonstrating the safety and feasibility of Stimulan® use in the setting of cardiac surgery and infective endocarditis. Learning objective: Infective endocarditis surgery may benefit from the use of an on-site antibiotic carrier, especially when surgery is urgent, and an extended period of systemic treatment is not feasible. Drawing upon the expertise acquired from orthopedic surgery, the use of a topical antibiotic in a slow-release formulation can be safely deployed at the site of infection, close to a prosthetic aortic valve.