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Rifampin therapy of Staphylococcus epidermidis. Use in infections from indwelling artificial devices
Abstract:
Rifampin was added to existing antibiotic regimens in two patients with Staphylococcus epidermidis infections; one patient had prosthetic valve endocarditis and the other had an infection of a CSF shunt. The addition of rifampin increased serum or CSF bactericidal titers 16-fold or greater and was correlated with a favorable clinical response. The results of tests for tube-dilution antibiotic susceptibility showed rifampin to be the most active of all antibiotics tested against the patients' organisms. The combinations of gentamicin sulfate, nafcillin sodium, or vancomycin hydrochloride with rifampin prevented the emergence of rifampin resistance in vitro and promoted enhanced killing when compared with either antibiotic alone.
Insights
Adding rifampin to antibiotic regimens significantly boosted bactericidal activity against Staphylococcus epidermidis infections. This combination therapy improved clinical outcomes and prevented antibiotic resistance.
Area of Science:
- Infectious Diseases
- Pharmacology
- Cardiology
Background:
- Staphylococcus epidermidis is a common cause of prosthetic device infections.
- Prosthetic valve endocarditis and cerebrospinal fluid (CSF) shunt infections are serious complications.
Observation:
- Two patients with S. epidermidis infections (prosthetic valve endocarditis and CSF shunt infection) received rifampin added to existing antibiotic regimens.
- Serum or CSF bactericidal titers increased 16-fold or greater after rifampin addition.
Findings:
- Rifampin demonstrated the highest in vitro activity against the tested organisms.
- Combinations of rifampin with gentamicin, nafcillin, or vancomycin showed enhanced killing and prevented rifampin resistance in vitro.
Implications:
- Rifampin combination therapy may be a valuable strategy for treating difficult S. epidermidis infections.
- This approach could improve patient outcomes in cases of prosthetic device infections.
- Further research is warranted to explore the efficacy of rifampin combinations in larger patient cohorts.