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Prosthetic valve endocarditis caused by Staphylococcus epidermidis. Development of rifampin resistance during
Abstract:
Development of rifampin-resistant Staphylococcus epidermidis was documented in three patients receiving vancomycin and rifampin therapy for prosthetic valve endocarditis. The minimum inhibitory concentrations and minimum bactericidal concentrations of rifampin for the original three isolates were 0.4 micrograms/mL or less. Organisms cultured during relapse or prosthetic valve replacement had minimum inhibitory concentrations of rifampin that were 12.5, 50, and greater than 100 micrograms/mL, respectively. Surgical intervention was necessary in all patients. One died, and one required a second prosthetic valve placement. The patients were treated with vancomycin plus aminoglycoside following identification of rifampin resistance. These observations suggest that vancomycin and rifampin may not be adequate therapy for prosthetic valve endocarditis caused by S epidermidis.
Insights
Rifampin resistance developed in Staphylococcus epidermidis during vancomycin and rifampin treatment for prosthetic valve endocarditis. This resistance necessitates alternative treatment strategies for S epidermidis infections.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Prosthetic valve endocarditis (PVE) is a severe infection requiring effective antimicrobial therapy.
- Staphylococcus epidermidis is a common pathogen in PVE, often necessitating combination therapy.
Observation:
- Three patients with PVE caused by S epidermidis developed resistance to rifampin while on vancomycin and rifampin treatment.
- Rifampin minimum inhibitory concentrations increased significantly from ≤0.4 µg/mL to >12.5 µg/mL in resistant isolates.
Findings:
- Vancomycin and rifampin combination therapy failed in these cases due to emergent rifampin resistance.
- All patients required surgical intervention, with significant morbidity and one mortality.
Implications:
- Vancomycin and rifampin may be inadequate for treating S epidermidis PVE.
- Alternative antibiotic regimens and surgical management are crucial for successful outcomes.