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Relapse of staphylococcal endocarditis after clindamycin therapy
The American Journal of the Medical Sciences
|January 1, 1975
Summary
Clindamycin therapy failed to eradicate Staphylococcus aureus endocarditis in a heroin user, leading to recurrent infection. This case highlights potential limitations of clindamycin for deep-seated intravascular infections, even with sensitive organisms.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Staphylococcus aureus endocarditis is a serious infection, particularly in intravenous drug users.
- Penicillin allergy necessitates alternative antibiotic choices, such as cephalothin and clindamycin.
- Deep-seated intravascular infections can be challenging to eradicate.
Purpose of the Study:
- To report a case of recurrent Staphylococcus aureus endocarditis.
- To evaluate the effectiveness of clindamycin in treating endocarditis in a patient with penicillin allergy.
- To illustrate the potential failure of clindamycin to eradicate deep-seated intravascular infections.
Main Methods:
- Case report of a 25-year-old female heroin user with Staphylococcus aureus endocarditis.
- Initial treatment with cephalothin due to penicillin allergy, followed by clindamycin due to lack of response.
- Organism identification, sensitivity testing, and phage typing confirmed recurrent infection with the same organism.
Main Results:
- Initial treatment with cephalothin was ineffective.
- Clindamycin therapy resulted in an excellent initial clinical response.
- The patient experienced recurrent endocarditis six days after discharge, despite six weeks of clindamycin treatment.
- The recurrent infection was caused by the identical Staphylococcus aureus strain.
Conclusions:
- Clindamycin may not be sufficient to eradicate deep-seated intravascular Staphylococcus aureus infections, even when the organism is sensitive.
- This case underscores the importance of considering treatment duration and potential for relapse in endocarditis management.
- Alternative or combination therapies might be necessary for certain patient populations and infection types.
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