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Prosthetic biologic valve endocarditis caused by a vancomycin-resistant (vanA) Enterococcus faecalis: case report.
P Carfagna1, A Tarasi, M Cassone
1Clinica Medica 3, Dipartimento di Medicina Clinica, Università La Sapienza Rome, Italy. pcarfagna@tin.it
Journal of Chemotherapy (Florence, Italy)
|December 29, 2000
Summary
This study reports a rare case of endocarditis caused by vancomycin-resistant Enterococcus faecalis in a patient with a prosthetic valve. Treatment with ampicillin and gentamicin was successful, highlighting therapeutic options for this challenging infection.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Endocarditis is a serious infection affecting heart valves, particularly prosthetic valves.
- Vancomycin-resistant Enterococcus faecalis (VRE) poses a significant challenge due to limited treatment options.
- Prosthetic valve endocarditis requires prompt diagnosis and effective antimicrobial therapy.
Observation:
- A 68-year-old patient presented with suspected endocarditis on a prosthetic biologic valve.
- The causative agent was identified as vancomycin-resistant Enterococcus faecalis (VRE) harboring the vanA gene.
- Transthoracic echocardiography did not reveal valvular vegetations, complicating the initial diagnosis.
Findings:
- The VRE strain was susceptible to ampicillin (MIC=0.5 microg/ml) and showed no high-level aminoglycoside resistance.
- The patient received an 8-week course of ampicillin and a 6-week course of gentamicin.
- Histological examination of the explanted mitral valve confirmed previous endocarditis, despite sterile cultures.
Implications:
- This case underscores the importance of considering VRE in prosthetic valve endocarditis.
- Combination therapy with ampicillin and gentamicin can be effective in treating VRE endocarditis.
- Early diagnosis and appropriate treatment are crucial for favorable outcomes in prosthetic valve endocarditis.