ppi-0903 and Heart-Valve-Diseases

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Bicuspid Aortic Valve Disease; Ceftaroline; Cephalosporins; Daptomycin; Endocarditis; Heart Defects, Congenital; Heart Valve Diseases; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Microbial Viability; Staphylococcal Infections; Treatment Outcome

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.

Topics: Adult; Anti-Bacterial Agents; Ceftaroline; Cephalosporins; Daptomycin; Drug Resistance, Multiple, Bacterial; Endocarditis, Bacterial; Fatal Outcome; Heart Valve Diseases; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mitral Valve; Staphylococcal Infections; Tricuspid Valve; Vancomycin