F.T., a 65-year-old man, presents with chief complaints of anorexia, fever, chills, and weight loss.

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F.T., a 65-year-old man, presents with chief complaints of anorexia, fever, chills, and weight loss. His medical history is significant for replacement of his mitral and aortic heart valves (both porcine) 1 year ago for aortic stenosis, mitral regurgitation, and mitral stenosis secondary to rheumatic heart disease. One month later he was readmitted with fever, a right pleural effusion, a pericardial friction rub, and pericarditis. The impression at that time was either postpericardiotomy or Dressler syndrome. F.T. was sent home on anti-inflammatory agents but failed to improve. After continued complaints of anorexia, nausea, chills, and fever to 101?F, he returned to the hospital. On readmission, his physical examination was noteworthy for a systolic ejection murmur at the left sternal border and 3+ pedal edema. Blood cultures were obtained, and routine laboratory studies were performed. His history and clinical presentation were strongly suggestive of prosthetic valve endocarditis (PVE). What are the most likely organisms responsible for PVE in F.T.?
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1 F.T., a 65-year-old man, presents with chief complaints of anorexia, fever, chills, and weight loss. His medical history is significant for replacement of his mitral and aortic heart valves (both porcine) 1 year ago for aortic stenosis, mitral regurgitation, and mitral stenosis secondary to rheumatic heart disease. One month later he was readmitted with fever, a right pleural effusion, a pericardial friction rub, and pericarditis. The impression at that time was either postpericardiotomy or Dressler syndrome. F.T. was sent home on anti-inflammatory agents but failed to improve. After continued complaints of anorexia, nausea, chills, and fever to 101?F, he returned to the hospital. On readmission, his physical examination was noteworthy for a systolic ejection murmur at the left sternal border and 3+ pedal edema. Blood cultures were obtained, and routine laboratory studies were performed. His history and clinical presentation were strongly suggestive of prosthetic valve endocarditis (PVE). What are the most likely organisms responsible for PVE in F.T.?
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