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Successful cure of daptomycin-non-susceptible, vancomycin-intermediate Staphylococcus aureus prosthetic aortic valve

Zarchi E Sumon1, Charles S Berenson1,2, John A Sellick1,2

  • 1a Department of Medicine, Infectious Diseases Division , University at Buffalo, Jacobs School of Medicine and Biomedical Sciences , Buffalo , NY , USA.

Infectious Diseases (London, England)
|February 15, 2019
PubMed

Insights

This study details a successful treatment for a rare Staphylococcus aureus prosthetic valve endocarditis. A combination therapy of daptomycin, ceftaroline, and rifampin cured the infection in eight weeks.

Area of Science:

  • Infectious Diseases
  • Antimicrobial Resistance
  • Cardiovascular Surgery

Background:

  • Infectious complications after surgical valve replacement are challenging to manage, often necessitating prolonged antimicrobial therapy or reoperation.
  • Vancomycin-intermediate Staphylococcus aureus (VISA) is an uncommon pathogen, accounting for less than 0.3% of cases, posing significant treatment difficulties.
  • Prosthetic valve endocarditis (PVE) caused by drug-resistant bacteria represents a critical clinical scenario.

Observation:

  • A case of PVE caused by daptomycin-non-susceptible and vancomycin-intermediate Staphylococcus aureus was encountered.
  • Standard treatment options were limited due to the specific resistance profile of the pathogen.
  • The patient presented with a complex infectious endocarditis requiring innovative therapeutic strategies.

Findings:

  • A combination antimicrobial regimen including daptomycin, ceftaroline, and rifampin was administered.
  • In vitro time-kill studies demonstrated synergistic activity, achieving a >4 log reduction in bacterial growth within 24 hours.
  • The eight-week course of this combination therapy resulted in a successful clinical outcome, eradicating the infection.

Implications:

  • This case highlights a potential effective treatment strategy for challenging PVE cases involving multidrug-resistant Staphylococcus aureus.
  • Combination therapy may overcome resistance mechanisms and improve outcomes in severe prosthetic valve endocarditis.
  • Further research into novel antimicrobial combinations is warranted for treating resistant bacterial infections in cardiovascular surgery.
Keywords:
Prosthetic valve endocarditistime-kill studyvancomycin-intermediate

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