Bacterial endocarditis due to penicillin-resistant Streptococcus viridans

Bacterial endocarditis remains a formidable diagnostic and therapeutic problem for clinicians. Streptococcus viridans still accounts for 45 to 50 per cent of all cases and between 5 to 10 per cent of all clinical isolates of Streptococcus viridans from patients with bacterial endocarditis may be relatively resistant to penicillin. The case of a 9-year-old child with Tetralogy of Fallot and a Waterston shunt who subsequently developed bacterial endocarditis due to penicillin-resistant Streptococcus viridans following failure of oral penicillin dental prophylaxis is presented. In the face of penicillin resistance, additional considerations for workup, including microbiological assays for antimicrobial synergism become necessary in the selection of a therapeutic regimen.