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Endocarditis due to Streptococcus faecalis with high-level resistance to gentamicin
1Department of Internal Medicine, University of California, Davis.
Abstract:
Recently, reports of Streptococcus faecalis with resistance to high levels of gentamicin have appeared in the literature, although there have been no previous reports of endocarditis due to such organisms. In this article, two cases of endocarditis--both due to Streptococcus faecalis with high-level gentamicin resistance and both presenting in an atypical manner--are described. The data suggest that a high level of suspicion regarding a diagnosis of endocarditis must be maintained in such cases and that, once a case is diagnosed, careful evaluation in the microbiology laboratory is helpful in determining the optimal antimicrobial regimen.
Insights
High-level gentamicin-resistant Streptococcus faecalis can cause endocarditis. Early diagnosis and tailored antimicrobial therapy are crucial for effective treatment of this challenging infection.
Area of Science:
- Infectious Diseases
- Microbiology
- Cardiology
Background:
- Reports of Streptococcus faecalis exhibiting high-level gentamicin resistance (HLGR) are emerging.
- Endocarditis caused by HLGR Streptococcus faecalis has not been previously documented.
Observation:
- This article details two cases of endocarditis.
- Both cases were caused by HLGR Streptococcus faecalis.
- Both patients presented with atypical symptoms.
Findings:
- High-level gentamicin resistance in Streptococcus faecalis is a potential cause of endocarditis.
- Atypical presentations necessitate a high index of suspicion for endocarditis.
- Microbiological evaluation is key to selecting appropriate antimicrobial regimens.
Implications:
- Clinicians should consider HLGR Streptococcus faecalis in suspected endocarditis cases, especially with unusual presentations.
- Accurate and timely laboratory diagnostics are essential for guiding treatment decisions.
- This finding highlights the need for vigilance regarding antimicrobial resistance in infective endocarditis.