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Staphylococcus aureus endocarditis. Combined therapy with vancomycin and rifampin
Abstract:
Two children with persistent bacteremia and endocarditis due to Staphylococcus aureus failed to respond to vancomycin therapy, even though serum levels greatly exceeded the inhibitory concentrations. The Staphylococcus from one patient was resistant to methicillin; the other patient had a penicillin hypersensitivity. There was a wide disparity between the minimum inhibitory and the minimum bactericidal concentrations of vancomycin. Striking clinical and laboratory evidence of improvement was demonstrated with the addition of rifampin therapy.
Insights
Vancomycin treatment failed for two children with Staphylococcus aureus infections. Adding rifampin therapy showed significant clinical improvement, suggesting its potential benefit in difficult cases.
Area of Science:
- Infectious Diseases
- Pharmacology
- Pediatrics
Background:
- Staphylococcus aureus infections, including bacteremia and endocarditis, pose significant clinical challenges.
- Vancomycin is a primary antibiotic for treating serious Gram-positive bacterial infections.
Observation:
- Two pediatric patients with persistent Staphylococcus aureus bacteremia and endocarditis did not respond to vancomycin therapy.
- Elevated vancomycin serum levels did not achieve therapeutic efficacy in these cases.
- One isolate was methicillin-resistant Staphylococcus aureus (MRSA), and the other patient had penicillin hypersensitivity.
Findings:
- A significant difference was observed between vancomycin's minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC).
- The addition of rifampin to vancomycin therapy resulted in marked clinical and laboratory improvements in both patients.
- Rifampin demonstrated synergistic or additive effects when combined with vancomycin.
Implications:
- Rifampin may be a valuable adjunctive therapy for severe Staphylococcus aureus infections refractory to vancomycin.
- This case highlights the importance of considering alternative or combination therapies when standard treatments fail.
- Further research is warranted to explore the role of rifampin in treating challenging Staphylococcus aureus endocarditis and bacteremia.