Oritavancin as sequential therapy for vancomycin-resistant Enterococcus faecium prosthetic valve endocarditis: a case...

Area of Science:

• Infectious Diseases
• Cardiology
• Pharmacology

Background:

• Prosthetic valve endocarditis (PVE) caused by vancomycin-resistant Enterococcus faecium (VRE) presents a significant therapeutic challenge, particularly in elderly patients.
• Healthcare-associated infections and multidrug-resistant organisms are prevalent in Greek hospitals, necessitating strategies to minimize prolonged hospital stays.

Purpose of the Study:

• To report a successful management strategy for VRE PVE in a 91-year-old patient.
• To evaluate the feasibility of sequential outpatient therapy with a long-acting lipoglycopeptide for VRE PVE.

Main Methods:

• Diagnosis of PVE was confirmed via positive blood cultures and transoesophageal echocardiography.
• Initial treatment involved intravenous daptomycin and fosfomycin for two weeks.
• Sequential therapy consisted of six weekly outpatient infusions of oritavancin.

Main Results:

• The patient achieved complete clinical and microbiological resolution of VRE PVE.
• No relapse was observed at six months post-treatment.
• Outpatient oritavancin infusions facilitated the completion of prolonged therapy, reducing hospitalization.

Conclusions:

• Sequential therapy with long-acting lipoglycopeptides like oritavancin is a viable option for outpatient management of VRE PVE.
• This strategy can be effective in selected elderly patients, addressing challenges of multidrug resistance and healthcare-associated infections.
• Avoiding oral linezolid due to potential toxicity and suboptimal levels in this patient population was a key consideration.