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Bacterial endocarditis with a tolerant staphylococcal organism
Clinical Pediatrics
|April 1, 1982
Summary
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.