Oral hygiene with chlorhexidine and bacterial resistance in intubated patients

and importance: Leuconostoc is a genus of gram-positive bacteria, this type of bacteria, which can be found in green vegetables and are used in wine, cheese, and sugar production, is an uncommon cause of disease in human beingsWe report the case of a 60 years old male, with a medical history of nasopharyngeal carcinoma treated by chemotherapy and radiotherapy. The patient was admitted for total hematuria and episodic fever for the last 2 months. blood test found an anemia at 5g/dl, hyperleukocytosis at 18,000/ml,The transthoracic echocardiography showed, moderate mitral regurgitation, severe mitral stenosis with a valve area of 1.5cm2, and a mobile vegetation measuring 14 × 6 mm on A2 part of the anterior mitral valve. Transesophageal echocardiography (TEE) showed a 16 × 8 mm mitral vegetation. An empirical antibiotic therapy then adapted to the antibiogramour patient is at an extremely elevated risk for infective endocarditis. This case is interesting because the pathogenic bacterial species for IE are typically staphylococci and streptococci, Two similar cases of Leuconostoc spp endocarditis were found in the literature, effective therapy of penicillin-resistant group viridians streptococci with combination therapy, our team opted for empiric treatment with ceftriaxone associated to gentamycinIt is critical for clinicians to be aware of the many pathogenic organisms, including Leuconostoc species. It is also clear that a higher index of suspicion must be maintained in patients with multiple predisposing factors such as the patient in the case presented.