Enterococcus faecalis Bacteremia Following Transurethral Resection of the Prostate (TURP): Urinary Sepsis or Infective Endocarditis?

Enterococcus faecalis is a gram-positive, facultative anaerobic bacterium that commonly colonizes the gastrointestinal and genitourinary tracts. Although frequently implicated in urinary tract infections and bacteremia, it is also a well-recognized cause of subacute infective endocarditis. We present a case of subacute infective endocarditis caused by Enterococcus faecalis, initially masked by presumed urinary sepsis in a patient who had undergone transurethral resection of the prostate (TURP) less than two months prior. The patient presented with four days of fever and generalized weakness, accompanied by clinical features of sepsis and urinalysis findings suggestive of urinary tract infection, indicating a possible urinary source. Empiric broad-spectrum antibiotic therapy was initiated for presumed urinary sepsis. However, persistent symptoms despite three days of treatment prompted further evaluation. Blood cultures grew Enterococcus faecalis, while urine cultures remained negative, raising suspicion for an alternative source of infection. After excluding intra-abdominal pathology through contrast-enhanced abdominopelvic computed tomography (CT), transthoracic echocardiography revealed mitral valve vegetation consistent with infective endocarditis. Targeted antimicrobial therapy with vancomycin for 14 days and ampicillin-sulbactam for 30 days resulted in complete clinical recovery and resolution of valvular vegetation without the need for surgical intervention. This case highlights the importance of maintaining a high index of suspicion for infective endocarditis in patients with Enterococcus faecalis bacteremia, particularly when no clear infectious focus is identified. Additionally, it underscores the potential association between TURP-related bacteremia and subsequent endocarditis. These findings emphasize the need to reassess and optimize perioperative prophylactic strategies in patients undergoing urological procedures, taking into account regional antibiotic resistance, in order to reduce the risk of severe systemic complications such as infective endocarditis