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Bacterial endocarditis with a tolerant staphylococcal organism

J A McMillan, L B Weiner

    Clinical Pediatrics
    |April 1, 1982
    PubMed

    Insights

    Staphylococcal endocarditis in a child showed tolerance to nafcillin, a form of antibiotic resistance. Adding rifampin improved the patient’s outcome, highlighting the importance of considering tolerance in severe infections.

    Area of Science:

    • Infectious Diseases
    • Microbiology
    • Pharmacology

    Background:

    • Staphylococcal endocarditis is a serious infection requiring effective antibiotic treatment.
    • Initial treatment with nafcillin and gentamicin did not resolve the patient's fever.

    Observation:

    • The patient, an eight-year-old boy, presented with staphylococcal endocarditis.
    • Despite initial antibiotic therapy, the patient remained febrile, suggesting treatment failure.

    Findings:

    • A significant discrepancy was observed between the minimum bactericidal concentration (MBC) and minimum inhibitory concentration (MIC) of nafcillin, with MBC being 130 times the MIC.
    • This large MBC/MIC ratio indicated bacterial tolerance to nafcillin.
    • The addition of rifampin to the antibiotic regimen led to the patient becoming afebrile and recovering.

    Implications:

    • Bacterial tolerance, a form of antibiotic resistance, must be recognized as a critical factor in treating life-threatening infections.
    • The findings underscore the need to assess antibiotic tolerance in cases of persistent or treatment-refractory infections.
    • Rifampin may be a valuable adjunctive therapy in managing staphylococcal endocarditis with documented nafcillin tolerance.

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