Case of Enterococcus faecalis Infective Endocarditis 6-weeks Following Post-partum Hemorrhage

Authors

Zohaib Nadeem, HCA HealthcareFollow
Mason Goforth, HCA HealthcareFollow
Yasasvi Sabbineni, HCA HealthcareFollow
Sadia Zahid
Yugandhra Devarapalli
Javed Akram
Veeranna Vibhuti

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2026

Keywords

peri-partum infective endocarditis, IE, Enterococcus faecalis

Disciplines

Bacterial Infections and Mycoses | Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences

Abstract

Peri-partum infective endocarditis (IE) is a rare but serious condition with high maternal and fetal morbidity and mortality. IE is exceedingly uncommon in young healthy patients, especially without any known risk factors such as intravenous (IV) drug use, congenital heart disease, or rheumatic heart disease. IE is estimated to complicate 0.00002% of in-hospital deliveries. Similar to the general population, staphylococcal and streptococcal species remain the most common pathogens in obstetric patients. Enterococcal species make up less than 10% of IE cases in pregnant women. Very few cases of enterococcal IE in the post-partum period are reported in the literature. We describe a case of a 41-year-old female G7P5M2 with Enterococcus faecalis infective endocarditis 6 weeks following post-partum hemorrhage which was managed with intrauterine balloon pump. She initially presented to the emergency department with acute onset bilateral left sided peripheral vision loss and low-grade fevers. Initial vitals were within normal range. On examination she had left homonymous hemianopia and an early diastolic murmur loudest in the aortic region. Magnetic resonance imaging head showed an acute right occipital lobe infarct. Transthoracic echocardiogram found a 1x1cm aortic valve mass suspicious for vegetation in addition to moderate aortic regurgitation with a normal ejection fraction, which was confirmed by transesophageal echocardiogram. Blood cultures were positive for gram positive cocci, and she was empirically started on IV vancomycin and IV ceftriaxone. Based on the major parameters of the Modified Duke’s criteria she was diagnosed with infective endocarditis. Final blood culture results confirmed High-Level Aminoglycoside Resistant Enterococcus faecalis. She was switched to IV ampicillin and IV ceftriaxone for the remainder of her hospitalization. Cardiothoracic surgery was consulted and planned to re-evaluate outpatient for potential aortic valve replacement. After 2 consecutive negative blood cultures she was discharged home with a peripherally inserted central catheter line and a 6-week course of IV ceftriaxone and ampicillin with follow up with infectious disease, cardiothoracic surgery, and neurology. This case illustrates post-partum hemorrhage and urogenital interventions as risk factors for IE in the obstetric population.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Nadeem, Zohaib; Goforth, Mason; Sabbineni, Yasasvi; Zahid, Sadia; Devarapalli, Yugandhra; Akram, Javed; and Vibhuti, Veeranna, "Case of Enterococcus faecalis Infective Endocarditis 6-weeks Following Post-partum Hemorrhage" (2026). North Texas Research Forum 2026. 46.
https://scholarlycommons.hcahealthcare.com/northtexas2026/46