Tricuspid and mitral endocarditis due to methicillin-resistant Staphylococcus aureus exhibiting vancomycin-creep phenomenon

Pranathi R ao Sundaragiri, Saraschandra Vallabhajosyula, Toufik M ahfood Haddad, Dennis J. Esterbrooks

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Right-sided infective endocarditis (RIE) is commonly due to Staphylococcus aureus and often involves the tricuspid valve (TV). A 31-year-old man with prior intravenous drug use presented with substernal pain, cough, dyspnoea and fever. Examination revealed a febrile, tachycardic male with peripheral infective endocarditis stigmata and right-heart failure. Laboratory parameters demonstrated leucocytosis, lactic acidosis and methicillin-resistant S. aureus (MRSA) bacteraemia. Echocardiography demonstrated multiple TV echodensities and chest imaging confirmed septic emboli. The MRSA species demonstrated 'vancomycin-creep', necessitating therapy with daptomycin and ceftaroline. Owing to persistent bacteraemia and septic shock, the patient underwent TV surgery, but continued to have a poor postoperative course with subsequent death. Indications for surgical therapy of RIE are limited to the European guidelines and most data are extrapolated from left-heart disease. MRSA exhibiting vancomycin-creep portends a poorer prognosis and requires aggressive therapy. We advocate the use of ceftaroline salvage therapy with daptomycin, pending further trials.

Original languageEnglish (US)
JournalBMJ Case Reports
Volume2015
DOIs
StatePublished - 2015

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Tricuspid Valve
Vancomycin
Methicillin-Resistant Staphylococcus aureus
Endocarditis
Daptomycin
Bacteremia
Fever
Christianity
Salvage Therapy
Lactic Acidosis
Leukocytosis
Septic Shock
Embolism
Cough
Dyspnea
Echocardiography
Staphylococcus aureus
Heart Diseases
Thorax
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Tricuspid and mitral endocarditis due to methicillin-resistant Staphylococcus aureus exhibiting vancomycin-creep phenomenon. / Sundaragiri, Pranathi R ao; Vallabhajosyula, Saraschandra; Haddad, Toufik M ahfood; Esterbrooks, Dennis J.

In: BMJ Case Reports, Vol. 2015, 2015.

Research output: Contribution to journalArticle

Sundaragiri, Pranathi R ao ; Vallabhajosyula, Saraschandra ; Haddad, Toufik M ahfood ; Esterbrooks, Dennis J. / Tricuspid and mitral endocarditis due to methicillin-resistant Staphylococcus aureus exhibiting vancomycin-creep phenomenon. In: BMJ Case Reports. 2015 ; Vol. 2015.
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