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Experimental Endocarditis Model of Methicillin Resistant Staphylococcus aureus MRSA in Rat
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Tricuspid and mitral endocarditis due to methicillin-resistant Staphylococcus aureus exhibiting vancomycin-creep

Pranathi Rao Sundaragiri1, Saraschandra Vallabhajosyula2, Toufik Mahfood Haddad3

  • 1Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

BMJ Case Reports
|November 5, 2015
PubMed

Insights

Right-sided infective endocarditis (RIE) caused by Staphylococcus aureus can be severe. Vancomycin-creep in MRSA indicates a poor prognosis, requiring aggressive treatment like daptomycin and ceftaroline.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Critical Care Medicine

Background:

  • Right-sided infective endocarditis (RIE) commonly involves Staphylococcus aureus and the tricuspid valve (TV).
  • Intravenous drug use is a significant risk factor for RIE.
  • Limited guidelines exist for surgical intervention in RIE, often extrapolated from left-sided disease.

Observation:

  • A 31-year-old male with a history of intravenous drug use presented with symptoms of RIE, including fever, dyspnea, and right-heart failure.
  • Laboratory findings revealed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with lactic acidosis.
  • Echocardiography showed multiple vegetations on the tricuspid valve, and chest imaging confirmed septic emboli.

Findings:

  • The MRSA isolate exhibited 'vancomycin-creep,' a phenomenon associated with reduced vancomycin susceptibility.
  • Despite treatment with daptomycin and ceftaroline, the patient experienced persistent bacteremia and septic shock.
  • Surgical intervention for the tricuspid valve did not improve the patient's outcome, leading to death.

Implications:

  • Vancomycin-creep in MRSA-RIE portends a poorer prognosis and necessitates aggressive therapeutic strategies.
  • Ceftaroline salvage therapy in combination with daptomycin may be a viable option for refractory MRSA-RIE.
  • Further clinical trials are needed to establish optimal treatment guidelines for complex RIE cases, particularly those involving vancomycin-creep.

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