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Rifampin treatment of prosthetic valve endocarditis due to Staphylococcus epidermidis
Abstract:
Twenty-three patients with prosthetic valve endocarditis caused by methicillin-resistant Staphylococcus epidermidis were studied retrospectively for assessment of the role of rifampin treatment. Rifampin (900-1,200 mg daily) was administered in combination with either vancomycin or a beta-lactam antibiotic for an average of 38 days. Eight patients also received an aminoglycoside. Infection was cured in 16 (70%) of these patients; i.e., in 13 (87%) of 15 receiving rifampin plus vancomycin and in three (38%) of eight receiving rifampin plus a beta-lactam antibiotic (P = .025). The addition of rifampin to vancomycin regimens resulted in an increase in serum bactericidal activity. The selection of rifampin-resistant strains of S. epidermidis during treatment with a combination of antibiotics was noted in two patients with persistent infection. The rates of cure obtained with rifampin-beta-lactam combinations were similar to those obtained with beta-lactam agents alone; however, the cure rates obtained with rifampin plus vancomycin (with or without an aminoglycoside) were encouraging and merit further study.
Insights
Rifampin combined with vancomycin showed promising cure rates for prosthetic valve endocarditis caused by Staphylococcus epidermidis. This combination may be more effective than rifampin with beta-lactam antibiotics.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Cardiovascular Surgery
Background:
- Prosthetic valve endocarditis (PVE) poses a significant challenge, often requiring complex antimicrobial therapy.
- Methicillin-resistant Staphylococcus epidermidis (MRSA) is a common pathogen in PVE, necessitating effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of rifampin in combination with vancomycin or beta-lactam antibiotics for treating PVE caused by MRSA.
- To assess the impact of rifampin on serum bactericidal activity in PVE patients.
Main Methods:
- Retrospective study of 23 patients with MRSA PVE.
- Patients received rifampin (900-1,200 mg daily) combined with vancomycin or a beta-lactam antibiotic for an average of 38 days.
- Eight patients also received an aminoglycoside.
Main Results:
- Overall cure rate was 70% (16/23).
- Cure rates were significantly higher with rifampin plus vancomycin (87%; 13/15) compared to rifampin plus beta-lactam (38%; 3/8) (P = .025).
- Rifampin addition to vancomycin increased serum bactericidal activity; rifampin resistance emerged in two patients.
Conclusions:
- Rifampin combined with vancomycin demonstrates encouraging cure rates for MRSA PVE and warrants further investigation.
- Rifampin-beta-lactam combinations showed similar efficacy to beta-lactams alone.
- Monitoring for rifampin resistance is crucial in persistent infections.