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Endocarditis due to high level gentamicin resistant Enterococcus faecium

S S Das1, J R Anderson, A A Macdonald

  • 1Department of Medical Microbiology, St. Bartholomew's Hospital, West Smithfield, London, U.K.

The Journal of Infection
|March 1, 1994
PubMed
Summary
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This case highlights a rare Enterococcus faecium endocarditis resistant to gentamicin, complicating prior Streptococcus sanguis infection. Treatment options were limited, necessitating consideration of early valve surgery.

Area of Science:

  • Infectious Diseases
  • Bacteriology
  • Cardiology

Background:

  • Bacterial endocarditis poses significant treatment challenges.
  • Enterococcal infections, particularly with resistant strains, are a growing concern.
  • Gentamicin resistance in enterococci complicates synergistic therapy.

Observation:

  • A patient developed endocarditis caused by Enterococcus faecium with high-level gentamicin resistance.
  • This occurred after a successful treatment of Streptococcus sanguis endocarditis.
  • The infecting organism showed limited susceptibility, primarily to vancomycin, teicoplanin, pristinamycin, and daptomycin.

Findings:

  • This case represents the first reported instance of bacterial endocarditis due to gentamicin-resistant Enterococcus faecium.

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  • The infection presented a therapeutic dilemma due to the narrow spectrum of effective antibiotics.
  • High-level aminoglycoside resistance in enterococci was confirmed.

    • Implications:

    • Early heart valve replacement surgery may be crucial for curing endocarditis caused by gentamicin-resistant enterococci.
    • Screening for high-level aminoglycoside resistance in enterococci is vital for all severe infections.
    • This underscores the need for careful antibiotic selection and consideration of surgical intervention in complex endocarditis cases.