rifampin and Endocarditis--Bacterial

Brucellosis, a zoonotic infection caused by the genus Brucellae, is an ancient condition linked to the consumption of milk and milk products. The disease has global importance due to its impact. Therapeutic options for brucellosis rely mostly on uncontrolled, nonrandomized, non-blinded studies. The choice and duration of therapy are related to patient characteristics and the presence of a focal disease. The usual therapy of acute brucellosis is a combination of doxycycline plus rifampicin for 6 weeks. An aminoglycoside could be substituted for rifampin for the initial week of combination therapy. Other alternatives include a combination of doxycycline plus trimethoprim-sulfamethoxazole, or a fluoroquinolone plus rifampicin. The presence of spondylitis or endocarditis usually indicates that the required treatment will be of a longer duration or a combination of therapy. The article has the discussion of some recent patents related to antibiotic susceptibility and Brucellosis.

Topics: Anti-Bacterial Agents; Bone Diseases, Infectious; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Patents as Topic; Rifampin; Spondylitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Coagulase negative staphylococci are the principal cause of prosthetic valve endocarditis but are a rare cause of native valve infections. However, the incidence of native valve endocarditis is increasing. Staphylococcus capitis is a coagulase negative staphylococcus with the capacity to cause endocarditis on native heart valves. Two cases of native valve endocarditis caused by S capitis are presented; both in patients with aortic valve disease. The patients were cured with prolonged intravenous vancomycin and rifampicin and did not need surgery during the acute phase of the illness. Five of the six previously described cases of endocarditis caused by this organism occurred on native valves and responded to medical treatment alone.

Topics: Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Male; Middle Aged; Rifampin; Staphylococcal Infections; Vancomycin

Because of the increasing number of renal transplantations performed and the rarity of reported cases of infective endocarditis in these patients, we studied the clinical characteristics of this infection in this population. We report on two cases from our experience and review reported cases of infective endocarditis in renal transplant recipients retrieved from the MEDLINE system. In addition, we reviewed a large series of infective endocarditis looking for patients with renal transplants. In addition to our 2 cases, 12 previously reported cases were found. The mean time from transplantation to diagnosis of infective endocarditis was 3.5 years (range 2 months to 15 years). Causative organisms included fungi, Staphylococcus aureus (3 cases each), Corynebacterium sp. (2 cases), Streptococcus viridans, VRE, Brucella sp., Clostridium sp., Nocardia sp. and Erysipelothrix sp. (one case each). Skin manifestations of endocarditis and/or splenomegaly were not reported in these patients. Septic emboli and mycotic aneurysms were relatively common. The overall mortality rate was 50% (7 of 14 patients died). Infective endocarditis seems to be rare in renal transplant recipients. The few reported cases are characterized by unusual causative micro-organisms and atypical clinical presentation. Further studies are needed to delineate the magnitude and scope of this association.

Topics: Adult; Brucella melitensis; Brucellosis; Ceftriaxone; Cephalosporins; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Erysipelothrix; Erysipelothrix Infections; Female; Humans; Kidney Transplantation; Male; MEDLINE; Postoperative Complications; Rifampin

Topics: Adult; Child; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Q Fever; Rifampin; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Carrier State; Cloxacillin; Drug Interactions; Drug Therapy, Combination; Endocarditis, Bacterial; Furunculosis; Humans; Methicillin; Oxacillin; Penicillin Resistance; Phagocytes; Rifampin; Staphylococcal Infections

The literature on the clinical use of rifampicin in combination for the treatment of non-mycobacterial diseases is reviewed. From the published evidence, the most promising associations are, for staphylococcal infections, gentamicin, erythromycin, kanamycin and fusidic acid. In the field of Gram-negative infections, Psuedomonas-induced sepsis in particular, data are not so impressive but promising results have been obtained with the associated use of rifampicin and gentamicin or colistin. Some systemic fungal diseases may be successfully treated with rifampicin in combination with amphotericin-B. Although only few reports are available on this subject, the importance of such an application is stressed in view of the severity of these diseases and of the lack of appropriate treatments.

Topics: Amphotericin B; Cephalosporins; Chloramphenicol; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Gentamicins; Humans; Kanamycin; Lincomycin; Mycoses; Nalidixic Acid; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Sulfamethoxazole; Tetracyclines; Trimethoprim; Urinary Tract Infections; Vancomycin

Topics: Abnormalities, Drug-Induced; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Chemical and Drug Induced Liver Injury; Drug Interactions; Drug Resistance, Microbial; Endocarditis, Bacterial; Gonorrhea; Humans; Intestinal Absorption; Leprosy; Meningococcal Infections; Mycobacterium; Respiratory Tract Infections; Rifampin; Thrombocytosis; Tuberculosis; Tuberculosis, Pulmonary; Urologic Diseases; Viruses

Topics: Anti-Bacterial Agents; Antitubercular Agents; Cephalosporins; Endocarditis, Bacterial; Enteritis; Gentamicins; Humans; Infections; Lincomycin; Meningitis; Penicillins; Rifampin; Sepsis; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Urinary Tract Infections; Vancomycin

To compare the efficacy and safety of inpatient oral antibiotic treatment (oral) versus standard parenteral antibiotic treatment (intravenous) for right-sided staphylococcal endocarditis in injection drug users.. In a prospective, randomized, non-blinded trial, febrile injection drug users were assigned to begin oral or intravenous (IV) treatment on admission, before blood culture results were available. Oral therapy consisted of ciprofloxacin and rifampin. Parenteral therapy was oxacillin or vancomycin, plus gentamicin for the first 5 days. Antibiotic dosing was adjusted for renal dysfunction. Administration of other antibacterial drugs was not permitted during the treatment or follow-up periods. Bacteremic subjects having right-sided staphylococcal endocarditis received 28 days of inpatient therapy with the assigned antibiotics. Test-of-cure blood cultures were obtained during inpatient observation 6 and 7 days after the completion of antibiotic therapy, and again at outpatient follow-up 1 month later. Criteria for treatment failure and for drug toxicity were prospectively defined.. Of 573 injection drug users who were hospitalized because of a febrile illness and suspected right-sided staphylococcal endocarditis, 93 subjects (16.2%) had two or more sets of blood cultures positive for staphylococci; 85 of these bacteremic subjects (14.8%) satisfied diagnostic criteria for at least possible right-sided staphylococcal endocarditis (no other source of bacteremia was apparent) and entered the trial. Forty-four (oral, 19; IV, 25) of these 85 subjects completed inpatient treatment and evaluation including test-of-cure blood cultures. There were four treatment failures (oral, 1 [5.2%]; IV, 3 [12.0%]; not significant, Fisher's exact test). Drug toxicity was significantly more common in the parenterally treated group (oral, 3%; IV, 62%; P < 0.0001), consisting largely of oxacillin-associated increases in liver enzymes.. For selected patients with right-sided staphylococcal endocarditis, oral ciprofloxacin plus rifampin is effective and is associated with less drug toxicity than is intravenous therapy.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Ciprofloxacin; Endocarditis, Bacterial; Female; Gentamicins; Humans; Infusions, Intravenous; Length of Stay; Male; Oxacillin; Penicillins; Prospective Studies; Rifampin; Staphylococcal Infections; Substance Abuse, Intravenous; Treatment Outcome; Vancomycin

To determine the median response time to therapy with vancomycin alone or with vancomycin plus rifampin in patients with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis.. Cohort analysis of a randomized study.. University medical center.. Forty-two consecutive patients with MRSA endocarditis were randomly assigned to receive either vancomycin (group I) or vancomycin plus rifampin (group II) for 28 days.. Clinical signs and symptoms were recorded, and blood cultures were obtained daily to determine the duration of bacteremia.. The median duration of bacteremia was 9 days (7 days for group I and 9 days for group II). The median duration of fever for all patients and for each treatment group was 7 days. Six patients failed therapy, including three patients who died 5, 6, and 9 days after therapy was started, respectively. The other three patients who failed therapy required valve surgery on days 2, 22, and 27, respectively. Although patients had sustained bacteremia, no unusual complications were seen in either treatment group, and most patients responded to continued antibiotic therapy.. Slow clinical response is common among patients with MRSA endocarditis who are treated with vancomycin or vancomycin plus rifampin. Nevertheless, few complications appear to be related solely to this sustained bacteremia.

Topics: Adult; Bacteremia; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Fever; Gentamicins; Humans; Male; Methicillin Resistance; Middle Aged; Prospective Studies; Rifampin; Staphylococcal Infections; Statistics as Topic; Time Factors; Vancomycin

We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment. Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized. Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case). Two patients died before the beginning of the treatment. Nineteen patients had hemodynamic failure and subsequently underwent valve replacement. Nine valve tissue cultures were positive despite previous antibiotic treatment. In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant. We conclude that the addition of quinolones to doxycycline is beneficial. On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics. We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.

Topics: 4-Quinolones; Anti-Infective Agents; Coxiella; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Q Fever; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

In the POET (Partial Oral Endocarditis Treatment) trial, oral step-down therapy was noninferior to full-length intravenous antibiotic administration. The aim of the present study was to perform pharmacokinetic/pharmacodynamic analyses for oral treatments of infective endocarditis to assess the probabilities of target attainment (PTAs).. Plasma concentrations of oral antibiotics were measured at day 1 and 5. Minimal inhibitory concentrations (MICs) were determined for the bacteria causing infective endocarditis (streptococci, staphylococci, or enterococci). Pharmacokinetic/pharmacodynamic targets were predefined according to literature using time above MIC or the ratio of area under the curve to MIC. Population pharmacokinetic modeling and pharmacokinetic/pharmacodynamic analyses were done for amoxicillin, dicloxacillin, linezolid, moxifloxacin, and rifampicin, and PTAs were calculated.. A total of 236 patients participated in this POET substudy. For amoxicillin and linezolid, the PTAs were 88%-100%. For moxifloxacin and rifampicin, the PTAs were 71%-100%. Using a clinical breakpoint for staphylococci, the PTAs for dicloxacillin were 9%-17%.Seventy-four patients at day 1 and 65 patients at day 5 had available pharmacokinetic and MIC data for 2 oral antibiotics. Of those, 13 patients at day 1 and 14 patients at day 5 did only reach the target for 1 antibiotic. One patient did not reach target for any of the 2 antibiotics.. For the individual orally administered antibiotic, the majority reached the target level. Patients with sub-target levels were compensated by the administration of 2 different antibiotics. The findings support the efficacy of oral step-down antibiotic treatment in patients with infective endocarditis.

Topics: Amoxicillin; Anti-Bacterial Agents; Dicloxacillin; Endocarditis; Endocarditis, Bacterial; Humans; Linezolid; Microbial Sensitivity Tests; Moxifloxacin; Rifampin

Topics: Anti-Bacterial Agents; Endocarditis; Endocarditis, Bacterial; Humans; Linezolid; Rifampin; Staphylococcal Infections

Linezolid in combination with rifampicin has been used in treatment of infective endocarditis especially for patients infected with staphylococci.. Because rifampicin has been reported to reduce the plasma concentration of linezolid, the present study aimed to characterize the population pharmacokinetics of linezolid for the purpose of quantifying an effect of rifampicin cotreatment. In addition, the possibility of compensation by dosage adjustments was evaluated.. Pharmacokinetic measurements were performed in 62 patients treated with linezolid for left-sided infective endocarditis in the Partial Oral Endocarditis Treatment (POET) trial. Fifteen patients were cotreated with rifampicin. A total of 437 linezolid plasma concentrations were obtained. The pharmacokinetic data were adequately described by a one-compartment model with first-order absorption and first-order elimination.. We demonstrated a substantial increase of linezolid clearance by 150% (95% CI: 78%-251%), when combined with rifampicin. The final model was evaluated by goodness-of-fit plots showing an acceptable fit, and a visual predictive check validated the model. Model-based dosing simulations showed that rifampicin cotreatment decreased the PTA of linezolid from 94.3% to 34.9% and from 52.7% to 3.5% for MICs of 2 mg/L and 4 mg/L, respectively.. A substantial interaction between linezolid and rifampicin was detected in patients with infective endocarditis, and the interaction was stronger than previously reported. Model-based simulations showed that increasing the linezolid dose might compensate without increasing the risk of adverse effects to the same degree.

Topics: Anti-Bacterial Agents; Endocarditis, Bacterial; Humans; Linezolid; Mitomycin; Rifampin

International guidelines recommend rifampin-based combinations for staphylococcal prosthetic valve endocarditis (PVE). However, no robust clinical data support this recommendation, and rifampin tolerability is an issue. We aimed to evaluate the impact of rifampin for the treatment of staphylococcal PVE.. An observational retrospective cohort study of all adults with staphylococcal PVE (modified Duke criteria) was conducted in 3 referral centers for endocarditis, during years 2000-2018. Primary outcome measurement was 1-year mortality.. We enrolled 180 patients with PVE due to Staphylococcus aureus (n = 114, 63.3%), or coagulase-negative staphylococci (n = 66, 36.7%), on bioprosthesis (n = 111, 61.7%), mechanical valve (n = 67, 37.2%), or both (n = 2). There were 132 males (73.3%), and mean age was 70.4 ± 12.4 years. Valvular surgery was performed in 51/180 (28.3%) cases. Despite all isolates were susceptible to rifampin, only 101 (56.1%) were treated with rifampin, for a median duration of 33.0 days, whereas 79 (43.9%) received no rifampin. Baseline characteristics were similar in both groups. One-year mortality was, respectively, 37.6% (38/101), and 31.6% (25/79), in patients treated with, or without, rifampin (P = .62). Relapse rates were 5.9% (6/101), and 8.9% (7/79), P = .65. Patients treated with rifampin had longer hospital length-of-stay: 42.3 ± 18.6 vs 31.3 ± 14.0 days (P < .0001). On multivariate analysis, only cerebral emboli (odds ratio [OR] 2.95, 95% confidence interval [CI], 1.30-6.70, P = .009), definite endocarditis (OR 7.15, 95% CI, 1.47-34.77, P = .018), and methicillin-resistant S. aureus (OR 6.04, 95% CI, 1.34-27.26, P = .019), were associated with 1-year mortality.. A large proportion (43.9%) of staphylococcal PVE received no rifampin. One-year survival and relapse rates were similar in patients treated with or without rifampin.

Topics: Adult; Aged; Aged, 80 and over; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Staphylococcal Infections

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Bacteremia; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Pulmonary Edema; Renal Dialysis; Respiratory Insufficiency; Rifampin; Skin Diseases, Vascular; Staphylococcal Infections; Vasculitis

Herein, we describe a rare case of Corynebacterium jeikeium endocarditis that silently progressed in a 65-year-old man undergoing hemodialysis. Because routine monthly blood examination revealed high C-reactive protein levels, blood cultures were collected, although he had no symptom and was afebrile. After 2 days, a Gram-positive rod was detected in one set of the blood culture. Furthermore, transthoracic echocardiography revealed new aortic regurgitation (AR) and vegetations, and, therefore, infective endocarditis was suspected. Transesophageal echocardiography showed vegetations with a maximum diameter of 8 mm on his aortic valve, with some valve destruction. C. jeikeium was identified in three sets of blood cultures. Administration of daptomycin was started because he had vancomycin allergy. Judging from the high risk of embolization due to vegetations, emergency aortic valve replacement was performed on the second day. C. jeikeium was detected in a resected cardiac valve specimen and blood. This case emphasizes that physicians should always consider the possibility of infective endocarditis even in hemodialysis patients without any symptoms.

Topics: Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Aortic Valve Insufficiency; Blood Culture; C-Reactive Protein; Combined Modality Therapy; Corynebacterium; Daptomycin; Diagnostic Tests, Routine; Echocardiography; Echocardiography, Transesophageal; Endocarditis, Bacterial; Hematologic Tests; Humans; Incidental Findings; Male; Renal Dialysis; Rifampin; Treatment Outcome

Brucellosis is one of the most frequent zoonotic infections. Cardiac involvement is rare and when involved, affects aortic valve the most. The appearance of a new murmur on clinical examination during sepsis should suspect seeding on valves. Our patient had pulmonary valve endocarditis secondary to brucellosis which was managed with pharmacotherapy as there was no valvular pathology. Triple therapy is standard of care and usually given for months, non-response to pharmacological treatment warrants surgical intervention. Our patient completed the triple-drug regimen at 3 months and is asymptomatic at present.

Topics: Adolescent; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Echocardiography, Transesophageal; Endocarditis, Bacterial; Humans; Male; Pulmonary Valve; Rifampin; Streptomycin

In Denmark, Q fever has previously been considered a rare and imported disease; however, recent testing of antibodies in cattle as well as humans has indicated that the infection is widespread. A 76-year-old Danish man was diagnosed with infective endocarditis and underwent open surgical aortic valve replacement with insertion of a biological valve. Due to paravalvular leakage, destruction of the aortic annulus, and an aortic root abscess, the patient underwent re-operation 3 weeks later, with replacement of the biological valve and insertion of an aortic prosthetic tube. Despite treatment with various broad-spectrum antibiotic regimes, the patient died 3.5 months after initial hospital admission.. The causative agent was probed by PCR amplification of bacterial DNA on the removed prosthetic aortic valve using broad range primers targeting the variable regions V1-V3 of the 16S RNA gene. After identification of Coxiella burnetii, multispacer sequence typing (MST) was performed by PCR amplification of 10 intergenic sequences.. BLAST analysis of DNA from prosthetic valve material identified a 16S rRNA gene fragment almost identical to the type strain of C. burnetii (462/463 nt). Molecular typing allocated the strain to MST_18.. Molecular methods are increasingly used to characterize isolates and to determine relationships between isolates that cause disease in different contexts and geographical areas. The present case demonstrates that identification and typing of C. burnetii is achievable without access to biosafety level 3 containment and highlights the first molecular characterization of an uncultured strain of C. burnetii causing infective endocarditis.

Topics: Abscess; Aged; Aortic Valve; Coxiella burnetii; Denmark; DNA, Bacterial; Doxycycline; Echinocandins; Endocarditis, Bacterial; Fatal Outcome; Gentamicins; Heart Valve Prosthesis; Humans; Male; Meropenem; Metronidazole; Multilocus Sequence Typing; Rifampin; RNA, Ribosomal, 16S; Vancomycin

Query fever (Q fever), caused by

Topics: Adult; Aged; Anti-Bacterial Agents; California; Chronic Disease; Doxycycline; Endocarditis, Bacterial; Hospitals, Veterans; Humans; Hydroxychloroquine; Male; Middle Aged; Q Fever; Retrospective Studies; Rifampin

The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C.. This before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia.. The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005).. The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.

Topics: Administration, Intravenous; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE).. From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin.. Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis.. The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.

Topics: Aged; Anti-Bacterial Agents; Cloxacillin; Endocarditis, Bacterial; Female; Gentamicins; Heart Failure; Heart Valve Prosthesis; Humans; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Prosthesis-Related Infections; Renal Insufficiency; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Rifampin is recommended as adjunctive treatment for staphylococcal prosthetic valve endocarditis (PVE). It is unclear whether this should hold for surgically treated patients. The purpose of this study was to examine whether adjunctive rifampin treatment in addition to cell wall active antimicrobial agents in patients with surgically treated staphylococcal infective endocarditis (IE) results in better outcomes.. Patients operated on for staphylococcal IE from April 1, 2008, to July 1, 2014, were identified from our institution's IE registry. Rifampin treatment was defined as 3 or more days of rifampin postoperatively. Cox proportional hazards regression was used to compare a composite outcome of death or reoperation for IE relapse, between patients treated and not treated with rifampin, adjusted for propensity to be treated with rifampin, methicillin resistance, all-purpose refined diagnosis related group (APR-DRG) severity score, and APR-DRG mortality risk.. In all, 273 patients were identified. The mean age was 56 years, 66% were male, 50% had PVE, 60% had S. aureus or S. lugdunensis infection, 89% had left side involvement, and 57% had invasive disease. Fifty-one (27%) received 3 or more days of rifampin postoperatively. Ninety-two patients died or underwent reoperation for IE relapse at a median of 205 days (interquartile range 56 to 718 days). In a multivariable model, patients treated with rifampin had a similar hazard of death or reoperation for IE relapse as those not treated (hazard ratio 0.76, 95% confidence interval 0.44 to 1.32, p value 0.34). The results were robust to varying definitions of rifampin treatment.. Among patients with surgically treated staphylococcal IE there was insufficient evidence to claim a reoperation-free survival benefit from treatment with rifampin. Rifampin should not be used as adjunctive therapy for staphylococcal IE in patients who have undergone surgical procedures for its treatment.

Topics: Adult; Aged; Anti-Bacterial Agents; Combined Modality Therapy; Drug Evaluation; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Practice Guidelines as Topic; Propensity Score; Proportional Hazards Models; Recurrence; Reoperation; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus lugdunensis; Treatment Failure

To study the characteristics of patients with Propionibacterium acnes prosthetic valve endocarditis (PVE) who required surgery.. A single-centre retrospective cohort study was conducted during a 7-year period. Patients with definite infective P. acnes endocarditis, according to the modified Duke criteria, were included. An extended culture protocol was applied. Information on medical health status, surgery, antibiotic treatment and mortality was obtained.. Thirteen patients fulfilled the criteria for P. acnes endocarditis (0.53% of 2466 patients with valve replacement in a 7-year period). All patients were male and had a previous valve replacement. The health status of patients was poor at diagnosis of P. acnes PVE. Most patients (11 of 13, 85%) were admitted with signs of heart failure due to a significant paravalvular leak; 2 of 13 (15%) patients presented with septic emboli. Twelve patients needed redo surgery, whereas one could be treated with antibiotic therapy only. The time between the index surgery and presentation with P. acnes PVE varied between 5 and 135 months (median 26.5 months). Replacement and reconstruction of the dysfunctional valve and affected anatomical structures was mainly performed with a mechanical valve (n = 5, 42%) or a (bio-) Bentall prosthesis (n = 6, 50%). Antibiotic therapy consisted of penicillin with or without rifampicin for 6 weeks after surgery. The mortality in this series was low (n = 1, 8%) and no recurrent endocarditis was found during a median follow-up of 38 months.. Propionibacterium acnes PVE is a rare complication after valve surgery. Redo surgery is often required. Treatment of the dysfunctional prosthetic aortic valve most often consists of root replacement, in combination with antibiotic therapy.

Topics: Adult; Aged; Anti-Bacterial Agents; Communicable Diseases; Endocarditis, Bacterial; Female; Gram-Positive Bacterial Infections; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Propionibacterium acnes; Prosthesis-Related Infections; Retrospective Studies; Rifampin

We report the successful use of daptomycin in a child with methicillin-resistant Staphylococcus aureus endocarditis with persistent bacteremia and clinical deterioration, despite treatment with vancomycin and rifampicin. She had acute kidney injury, requiring daptomycin dosage adjustment.

Topics: Anti-Bacterial Agents; Bacteremia; Child, Preschool; Daptomycin; Endocarditis, Bacterial; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections; Treatment Outcome; Vancomycin

A 33-year-old woman presented at 36 weeks gestation with worsening respiratory distress. A CT-pulmonary angiogram was performed to rule out a massive pulmonary embolism; instead, this identified extensive septic pulmonary emboli throughout both lung fields. Given the continuing maternal deterioration, a non-elective caesarean section was performed. A transoesophageal echocardiogram identified multiple large cardiac valve vegetations on both sides of her heart with an associated aortic root abscess. She responded well to a 6-week course of intravenous antibiotics.

Topics: Adult; Anti-Bacterial Agents; Coronary Angiography; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Floxacillin; Humans; Pregnancy; Pregnancy Complications, Infectious; Pulmonary Embolism; Respiratory Insufficiency; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

This case report describes the treatment of a rare infection caused by Staphylococcus lugdunensis with cefazolin and rifampin.. A 48-year-old man with significant comorbidities was admitted to our institution with complaints of malaise, shortness of breath, and vague persistent pain. He was diagnosed with S. lugdunensis infective endocarditis and was treated with cefazolin continuous infusion for 10 days without resolution of bacteremia. As surgical intervention was deemed inappropriate, rifampin was added to the treatment regimen for its antibiofilm activity. After rifampin initiation, resolution of bacteremia was rapidly achieved. Subsequent blood cultures remained negative, and the patient was discharged home in stable condition to complete six weeks of i.v. cefazolin and rifampin therapy. The patient continued treatment, as documented by the infusion center, weekly for five weeks. The patient was rehospitalized during his sixth week of treatment due to impending respiratory failure, whereupon he was intubated and admitted to the intensive care unit. The patient's cardiac status gradually worsened over the following days, and he ultimately died. Blood cultures from days 1 and 2 of hospitalization revealed no bacterial growth at five days.. Cefazolin and rifampin therapy in a hospitalized patient with bacteremia and aortic valve endocarditis caused by S. lugdunensis resulted in rapid eradication of the bacteremia. After more than five weeks of cefazolin-rifampin treatment, the patient was rehospitalized with worsening cardiac function and died. Blood cultures during the second admission were negative.

Topics: Anti-Bacterial Agents; Bacteremia; Cefazolin; Drug Therapy, Combination; Endocarditis, Bacterial; Fatal Outcome; Humans; Infusions, Intravenous; Liver Function Tests; Male; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus lugdunensis

Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.

Topics: Abattoirs; Aged; Animals; Anti-Bacterial Agents; Aortic Diseases; Bacteremia; Blood Vessel Prosthesis; Brucella abortus; Brucellosis; Doxycycline; Ecuador; Endarteritis; Endocarditis, Bacterial; Gentamicins; Humans; Male; Occupational Exposure; Prognosis; Rifampin; Ulcer

Endocarditis due to Propionibacterium acnes is a rare disease. Scant data on treatment of these infections is available and is based on case reports only. If the disease is complicated by abscess formation, surgical intervention combined with an antibiotic therapy might improve clinical outcome. In some cases, cardiac surgeons are reluctant to perform surgery, since they consider the intervention as high risk. Therefore, a conservative therapy is required, with little, if any evidence to choose the optimal antibiotic. We report the first case of a successfully treated patient with P. acnes prosthetic valve endocarditis without surgery.. We report the case of a 29-year-old patient with a prosthetic valve endocarditis and composite graft infection with abscess formation of the left ventricular outflow tract due to P. acnes. Since cardiac surgery was considered as high risk, the patient was treated intravenously with ceftriaxone 2 g qd and rifampin 600 mg bid for 7 weeks and was switched to an oral therapy with levofloxacin 500 mg bid and rifampin 600 mg bid for an additional 6 months. Two sets of blood cultures collected six weeks after completion of treatment remained negative. The patient is considered to be cured based on absence of clinical signs and symptoms, normal laboratory parameters, negative radiology scans and negative blood cultures, determined at site visits over two years after completion of treatment.. To our knowledge, this is the first successfully managed patient with P. acnes prosthetic valve endocarditis with abscess formation of the left ventricular outflow tract who was treated with antibiotics alone without a surgical intervention. A six month treatment with a rifampin and levofloxacin combination was chosen, based on the excellent activity against stationary-phase and adherent bacteria.

Topics: Abscess; Adult; Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Levofloxacin; Male; Middle Aged; Propionibacterium acnes; Prosthesis-Related Infections; Rifampin; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Bacterial Typing Techniques; Communicable Diseases, Emerging; Community-Acquired Infections; Endocarditis, Bacterial; Female; Gastrectomy; Genes, Bacterial; Gentamicins; Humans; Lymphoma, B-Cell, Marginal Zone; Methicillin-Resistant Staphylococcus aureus; Mitral Valve Insufficiency; Multiple Sclerosis; Neoplasms, Second Primary; Ovarian Neoplasms; Postoperative Complications; Rifampin; Staphylococcal Infections; Stomach Neoplasms; Vancomycin

Topics: Aged; Animals; Anti-Bacterial Agents; Bacteremia; Braces; Cattle; Combined Modality Therapy; Discitis; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Food Contamination; Gentamicins; Gram-Positive Bacterial Infections; Humans; Lactococcus; Lumbar Vertebrae; Milk; Ofloxacin; Pasteurization; Rifampin

We describe two cases of prosthetic valve endocarditis caused by Propionibacterium spp. successfully treated with a combination of rifampin and intravenous penicillin. Rifampin was chosen due to its promising activity against planktonic and biofilm Propionibacterium, its favourable minimal inhibitory concentrations, its excellent oral bioavailability and tissue penetration.

Topics: Actinomycetales Infections; Aged; Anti-Bacterial Agents; Aortic Valve; Bioprosthesis; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Penicillins; Propionibacterium; Rifampin

Vancomycin is the drug of choice in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infection. However, the presence of certain clinical complications like renal failure alters vancomycin pharmacokinetics, leading to drug accumulation and toxicity. This highlights the need to identify an effective substitute for treating MRSA infections when vancomycin cannot be used. We report the case of a 57-y-old Indian male diagnosed with tricuspid valve endocarditis with septicaemia and a right upper lobe cavity caused by MRSA. The patient also presented with renal failure, which precluded the use of vancomycin for treatment. A 6-week regimen of teicoplanin and rifampicin was used instead, and the infection was successfully treated. This case report provides evidence of the effectiveness of teicoplanin and rifampicin in the treatment of MRSA bacteraemia in situations where the use of vancomycin is contraindicated.

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; India; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Renal Insufficiency; Rifampin; Sepsis; Staphylococcal Infections; Teicoplanin; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Floxacillin; Humans; Practice Guidelines as Topic; Prosthesis-Related Infections; Rifampin

Although the presence of brucella endocarditis is encountered rarely, it is the most fetal complication of brucellosis, which is shown to affect the aortic valve primarily and the mitral valve secondarily. Involvement of the tricuspid valve is extremely rare. A 62-year-old female was admitted with complaints of fever, fatigue, difficulty in breathing, and swellings in her legs. A transthoracic echocardiogram was performed since acute right heart failure was considered due to her symptoms. The echocardiogram showed enlarged right heart chambers, serious tricuspid valve insufficiency, and a mass on the tricuspid valve compatible with a vegetation moving in and out of the right ventricle. Although no growths were observed in the blood culture, antibody titration for brucellosis was found to be 1/640 (+) in the serological examination. The patient was diagnosed with brucella endocarditis and placed on doxycycline, rifampicin, and ceftriaxone treatment for eight weeks. At the end of the eight-week treatment, the symptoms of right heart failure receded and the patient recovered from the endocarditis. Tricuspid valve brucella endocarditis should be considered in patients suffering from acute right heart failure accompanied by systemic infection findings since brucellosis is presently endemic in Turkey.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Ceftriaxone; Diagnosis, Differential; Doxycycline; Echocardiography; Electrocardiography; Endocarditis, Bacterial; Female; Heart Failure; Humans; Middle Aged; Rifampin; Treatment Outcome; Tricuspid Valve

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Biofilms; Combined Modality Therapy; Device Removal; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Electrodes, Implanted; Endocarditis, Bacterial; Equipment Failure; Female; Humans; Pacemaker, Artificial; Postoperative Complications; Radiography, Interventional; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Ultrasonography; Vancomycin

Topics: Animals; Anti-Bacterial Agents; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Fisheries; Gentamicins; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Lactococcus; Male; Middle Aged; Rifampin; Vancomycin; Zoonoses

We report the first case in the English language literature, to our knowledge, of native valve endocarditis due to Legionella pneumophila. The patient had no prior history of cardiothoracic intervention or congenital valvular process. A transesophageal echocardiogram showed a vegetation on the aortic valve. Blood culture and bronchoalveolar lavage returned positive for L. pneumophila. The patient was treated with levofloxacin for 6 weeks total after a second set of blood cultures were negative. The patient survived a complicated hospital course and was discharged to a rehabilitation facility.

Topics: Adult; Aortic Valve; Community-Acquired Infections; Endocarditis, Bacterial; Female; Humans; Immunosuppression Therapy; Legionella pneumophila; Levofloxacin; Ofloxacin; Rifampin

Daptomycin has demonstrated clinical efficacy in the treatment of methicillin-resistant Staphylococcus aureus-associated bacteremia and right-sided infective endocarditis. Although daptomycin is not approved for treatment of gram-positive pneumonia, clinical evidence suggests that it may be effective therapy for S. aureus-associated septic pulmonary emboli (SPE). We present our clinical experience with the use of daptomycin in combination with rifampin in four patients with SPE in the absence of infective endocarditis. Three of the patients had a history of injection drug use; two of these patients also had soft-tissue infections. All patients had clinical resolution of their infections. Daptomycin and rifampin appear to have a role in the treatment of methicillin-resistant S. aureus bacteremia with SPE in the absence of infective endocarditis and should be considered in patients that have failed therapy with vancomycin.

Topics: Adult; Aged; Anti-Bacterial Agents; Daptomycin; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pulmonary Embolism; Radiography; Rifampin; Sepsis; Staphylococcal Infections; Treatment Outcome

We report the case of a 64-year-old male patient with a prosthetic aortic valve who presented with clinical features of endocarditis confirmed by transoesophageal echocardiography. His blood cultures were positive for a very rare and newly described organism-Kytococcus schroeteri. The patient underwent aortic valve replacement and a 6-week course of intravenous antibiotics. This is the fifth reported case of endocarditis associated with this organism.

Topics: Actinomycetales; Actinomycetales Infections; Anti-Bacterial Agents; Aortic Valve; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Diseases; Humans; Male; Middle Aged; Prosthesis-Related Infections; Rifampin; Vancomycin

We report a case of probable iatrogenic vitamin K deficiency in the context of antibiotic treatment for endocarditis. The patient was initially admitted with breathlessness and treated for an exacerbation of chronic obstructive pulmonary disease. However, during this period the patient was further diagnosed with endocarditis following repeated temperature spikes. Following initiation of antibiotic treatment for endocarditis the patient was noted to become increasingly anaemic. The patient was noted to have prolonged prothrombin time despite no anticoagulants. Antibiotics have been reported to alter the gut flora causing vitamin K deficiency; thereby, resulting in coagulopathy. We give a brief overview and literature review regarding potential vitamin K deficiency in this clinical context.

Topics: Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Rifampin; Vancomycin; Vitamin K Deficiency

A 26-year-old pregnant woman who was an intravenous drug user (IDU) was admitted to our hospital for the treatment of tricuspid valve infective endocarditis (IE) and lung abscesses due to methicillin-resistant Staphylococcus aureus (MRSA). We started to treat her with vancomycin (VCM) alone and then in combination with rifampicin (RFP), but her condition did not improve. Then we added sulfamethoxazole/trimethoprim (SMZ/TMP) to VCM and RFP. After that, she improved rapidly. In Japan, there are very few reports about tricuspid valve IE caused by MRSA in IDUs. This case suggests that the combination of VCM, RFP, and SMZ/TMP may be effective for the treatment of severe MRSA infections.

Topics: Adult; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Lung Abscess; Methicillin-Resistant Staphylococcus aureus; Pregnancy; Pregnancy Complications, Infectious; Pulmonary Embolism; Rifampin; Staphylococcal Infections; Substance Abuse, Intravenous; Tricuspid Valve; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S. lugdunensis endocarditis. In this report the first case of S. lugdunensis endocarditis from Turkey was presented. A 37-year-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S. lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21st day of the therapy (9th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S. lugdunensis.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Bacteremia; Chemotherapy, Adjuvant; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Necrosis; Rifampin; Staphylococcal Infections; Staphylococcus; Sulbactam; Ultrasonography; Vancomycin

We retrospectively evaluated 105 patients at the Mayo Clinic between 1970 and 2006 with native valve endocarditis who underwent acute valve surgery. The objective was to determine if outcomes differed based on whether they had received an antibiotic regimen recommended for native valve endocarditis or one for prosthetic valve endocarditis. Fifty-two patients had streptococcal and 53 had staphylococcal infections. Patients with each type of infection were divided into two groups: the first received postoperative monotherapy (with a beta-lactam or vancomycin), and the second received combination therapy (with an aminoglycoside for streptococcal infection, and gentamicin and/or rifampin for staphylococcal infection). The duration and types of antibiotics given pre- and postoperatively, valve cultures results, antibiotic-related adverse events, relapses, and mortality rates within 6 months of surgery were analyzed. Cure rates were similar regardless of the regimen administered. With the small number of patients in each group, a multicenter study with a larger cohort of patients is needed to better define optimal postoperative treatment regimens in this population.

Topics: Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; beta-Lactams; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Retrospective Studies; Rifampin; Staphylococcal Infections; Streptococcal Infections; Treatment Outcome; Vancomycin

The need to investigate novel dosing regimens and combinations is essential in combating poor treatment outcomes for Staphylococcus aureus bacteremia and endocarditis. We evaluated the impact of simulated standard- and high-dose daptomycin in combination with gentamicin or rifampin against daptomycin-susceptible and nonsusceptible matched strains of S. aureus. These strains were collected from the daptomycin bacteremia and endocarditis clinical trial and consisted of three susceptible strains (MIC, 0.25 mg/liter) and four nonsusceptible isolates (MICs, 2 to 4 mg/liter). Daptomycin regimens of 6 and 10 mg/kg of body weight daily alone and in combination with gentamicin at 5 mg/kg daily or rifampin at 300 mg every 8 h were evaluated using an in vitro model with simulated endocardial vegetations over 96 h. Rapid bactericidal activity, identified by time to 99.9% kill, was displayed in all regimens with the daptomycin-susceptible strains. Concentration-dependent activity was noted by more-rapid killing with the 10-mg/kg/day dose. The addition of gentamicin improved activity in the majority of susceptible isolates. Daptomycin 6-mg/kg/day monotherapy displayed bactericidal activity for only one of the nonsusceptible isolates and for only two isolates with increased doses of 10 mg/kg/day. Combination regimens demonstrated improvement with some but not all nonsusceptible isolates. Three isolates developed a reduction in daptomycin susceptibility with 6-mg/kg/day monotherapy, but this was suppressed with both combination therapy and high-dose daptomycin. These results suggest that high-dose daptomycin therapy and combination therapy may be reasonable treatment options for susceptible isolates; however, more investigations are needed to confirm the variability of these regimens with nonsusceptible isolates.

Topics: Anti-Bacterial Agents; Culture Media; Daptomycin; Drug Evaluation, Preclinical; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Models, Biological; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Endocarditis due to Abiotrophia spp. occurs in about 5% of endocarditis cases. Most of the cases respond to a combination of penicillin and gentamicin, or vancomycin. We describe a case of Staphylococcus epidermidis (CONS) and Abiotrophia spp. endocarditis that failed vancomycin treatment, but responded to daptomycin and rifampin.

Topics: Adult; Anti-Bacterial Agents; Daptomycin; Endocarditis, Bacterial; Humans; Male; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Streptococcaceae

Topics: Abscess; Aged; Amoxicillin; Anti-Bacterial Agents; Aortic Valve; Bacteremia; Combined Modality Therapy; Device Removal; Endocarditis, Bacterial; Gentamicins; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Pacemaker, Artificial; Propionibacterium acnes; Prosthesis-Related Infections; Reoperation; Rifampin

Topics: Aged, 80 and over; Anti-Bacterial Agents; Cardiology; Daptomycin; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Endocarditis, Bacterial; Female; Humans; Incidental Findings; Interdisciplinary Communication; Lung Neoplasms; Medical Oncology; Pacemaker, Artificial; Patient Care Team; Pulmonary Disease, Chronic Obstructive; Pulmonary Medicine; Radiography; Referral and Consultation; Rifampin; Streptococcal Infections; Streptococcus sanguis; Thoracic Surgery

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Combined Modality Therapy; Daptomycin; Device Removal; Drug Therapy, Combination; Endocarditis, Bacterial; Fatal Outcome; Female; Gentamicins; Hip Prosthesis; Humans; Methicillin-Resistant Staphylococcus aureus; Mitral Valve; Postoperative Complications; Prosthesis-Related Infections; Respiratory Distress Syndrome; Rifampin; Staphylococcal Infections; Thrombocytopenia; Vancomycin

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Brucellosis; Ceftriaxone; Doxycycline; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Rifampin; Zoonoses

Kytoccoccus schroeteri is an emerging pathogen found mainly in association with prosthetic valve endocarditis. A striking aspect of this species is its resistance to penicillins, including isoxazolylpenicillins, making glycopeptide administration and valve replacement the treatment of choice. We present the case of a 38-year-old female diabetic patient with fever up to 39.1 degrees C for two months. Infection of her prosthetic aortic valve was suspected clinically. Repeated blood cultures revealed growth of K. schroeteri. Transesophageal echocardiography demonstrated a vegetation on the prosthetic aortic valve. Antibiotic treatment with vancomycin, rifampin and gentamicin was started and this regimen led to complete resolution of symptoms and disappearance of the vegetation. It is of particular interest that the patient recovered without further surgical procedures. Since the first description of K. schroeteri in 2002, four cases of endocarditis have been published, suggesting antecedent and continuing underdiagnosis.

Topics: Actinomycetales; Actinomycetales Infections; Adult; Aortic Valve Insufficiency; DNA, Bacterial; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Microbial Sensitivity Tests; Ofloxacin; Polymerase Chain Reaction; Rifampin; Vancomycin

To evaluate the efficacy of oral linezolid, with or without rifampicin, on valve vegetations and secondary foci of infection compared with vancomycin, in the absence or presence of rifampicin, in experimental endocarditis caused by methicillin-resistant Staphylococcus aureus.. Treatment groups were controls (n = 16), linezolid (n = 15), vancomycin (n = 15), linezolid and rifampicin (n = 15), vancomycin and rifampicin (n = 13), linezolid relapse (n = 11) and vancomycin relapse (n = 9). Therapy lasted 5 days in all groups, with survival of animals in the linezolid relapse and vancomycin relapse groups being recorded for an additional 5 days. Blood was drawn to determine the linezolid concentration, and valve vegetations, and kidney, liver, lung and spleen segments were collected for culture.. Survival in each individual group was higher than that in the control group; bacterial load in valve vegetations was reduced by all treatment regimens, with linezolid exhibiting bactericidal effects. Bactericidal activity of linezolid was noted in all secondary foci of infection except the lung, where only the combination of rifampicin with linezolid was bactericidal.. Orally administered linezolid is effective in limiting bacterial growth in the secondary foci of endocarditis. Co-administration of rifampicin favoured the suppression of bacterial growth in the lung.

Topics: Acetamides; Administration, Oral; Animals; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valves; Kidney; Linezolid; Liver; Lung; Male; Methicillin Resistance; Microbial Sensitivity Tests; Microbial Viability; Models, Animal; Oxazolidinones; Plasma; Rabbits; Rifampin; Spleen; Staphylococcal Infections; Staphylococcus aureus; Survival Analysis; Vancomycin

Staphylococcus aureus is a common cause of native valve infective endocarditis (IE). Rifampin is often added to traditional therapy for the management of serious S. aureus infections. There are no large, prospective studies documenting the safety and efficacy of adjunctive therapy with rifampin for treatment of native valve S. aureus IE. We reviewed all cases of definite native valve S. aureus IE confirmed by modified Duke criteria in a large urban hospital between 1 January 2004 and 31 December 2005. A retrospective cohort analysis was used to assess the impact of the addition of rifampin to standard therapy. There were 42 cases of S. aureus IE treated with the addition of rifampin and 42 controls. Cases received a median of 20 days of rifampin (range, 14 to 48 days). Rifampin-resistant S. aureus isolates developed in nine cases who received rifampin before clearance of bacteremia (56%), while significant hepatic transaminase elevations also occurred in nine cases, all of whom had hepatitis C infection. Unrecognized significant drug-drug interactions with rifampin occurred frequently (52%). Cases were more likely to have a longer duration of bacteremia (5.2 versus 2.1 days; P < 0.001) and were less likely to survive (79% versus 95%; P = 0.048) than controls. Our results suggest that the potential for hepatotoxicity, drug-drug interactions, and the emergence of resistant S. aureus isolates warrants a careful risk-benefit assessment before adding rifampin to standard antibiotic treatment of native valve S. aureus IE until further clinical studies are performed.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Cohort Studies; Drug Interactions; Drug Resistance, Bacterial; Endocarditis, Bacterial; Female; Heart Valve Diseases; Humans; Liver; Male; Middle Aged; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Only 3 cases of infective endocarditis (IE) due to methicillin-resistant Staphylococcus haemolyticus (MRSH) have been reported in English literature. Here we report 4 cases of IE due to MRSH encountered in a single university hospital. Population analysis of the strains was performed to assess the presence of vancomycin/teicoplanin heteroresistant subpopulations. Pulsed-field gel electrophoresis was used for molecular typing of isolates. IE was defined in 3 cases as health care associated, and in 1 case, as community acquired. A causative strain was lost. Two strains were heteroresistant to teicoplanin, and 1 also to vancomycin. Genome macrorestriction profile studies demonstrated that 2 MRSH isolates belonged to clones A and E, possessing a class C1 mecDNA, whereas 1 clone was sporadic. All patients were treated with vancomycin plus rifampin. Two patients were cured with antibiotic therapy alone, 1 patient needed surgery, and 1 patient died. Methicillin-resistant multiresistant S. haemolyticus may represent a difficult-to-treat cause of both community and nosocomially acquired IE.

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Bacteremia; Drug Therapy, Combination; Electrophoresis, Gel, Pulsed-Field; Endocarditis, Bacterial; Female; Humans; Male; Methicillin Resistance; Rifampin; Staphylococcal Infections; Staphylococcus haemolyticus; Vancomycin

Topics: Aminoglycosides; beta-Lactams; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Topics: Abscess; Adult; Anti-Bacterial Agents; Cloxacillin; Endocarditis, Bacterial; Fever; Humans; Levofloxacin; Male; Methicillin Resistance; Ofloxacin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Tricuspid Valve

A premature twin of 1.9 kg had mitral valve endocarditis develop during neonatal intensive care. Vegetation involving the entire anterior mitral valve leaflet was identified. Reconstruction was achieved by near complete resection of the anterior mitral valve leaflet and retention of the peripheral margin of coaptation including primary and secondary chordae. The body of the anterior mitral valve leaflet was reconstructed using fresh autologous pericardium, a technique not previously reported in an infant of this size. Three and a half years later, the child is well and has required no further intervention.

Topics: Bioprosthesis; Birth Weight; Captopril; Combined Modality Therapy; Diseases in Twins; Diuretics; Endocarditis, Bacterial; Female; Gentamicins; Humans; Hypertension, Pulmonary; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Methicillin Resistance; Mitral Valve; Mitral Valve Insufficiency; Pericardium; Rifampin; Staphylococcal Infections; Transplantation, Autologous; Twins, Monozygotic; Vancomycin

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve. Due to characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are obtained with surgery combination. We describe a case of Brucella endocarditis involving the aortic valve suspected in front of the clinical data and the results of serology, confirmed by the culture of the native valves. In association with the medical treatment, management valve replacement lead to a favorable medium-term evolution.

Topics: Anti-Bacterial Agents; Aortic Valve; Aortic Valve Insufficiency; Brucellosis; Doxycycline; Endocarditis, Bacterial; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Rifampin

Topics: Anti-Bacterial Agents; Aortic Valve; Brain Abscess; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Floxacillin; Gentamicins; Heart Valve Diseases; Humans; Middle Aged; Mitral Valve; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Catheters, Indwelling; Diabetes Complications; Discitis; Endocarditis, Bacterial; Fever; Heart Valve Prosthesis; Humans; Hyperparathyroidism, Secondary; Incidence; Kidney Failure, Chronic; Lumbar Vertebrae; Methicillin Resistance; Prognosis; Renal Dialysis; Rifampin; Spain; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Coxiella burnetii, the etiologic agent of Q fever, is mainly responsible for endocarditis with negative blood culture results, but only a few cases of C. burnetii infections of aortic aneurysms have been published. We report three cases of abdominal aortic aneurysms treated in patients with Q fever infection with simultaneous endocarditis (n = 1) and previous history of cardiac valve replacement for endocarditis (n = 1). A coeliac aortic aneurysm was diagnosed in one patient treated for acute Q fever with persistent serologic results showing chronic infection despite adequate antibiotic therapy and without endocarditis. Resection of the aneurysm cured the chronic infection, and C. burnetii was identified by culture of the aneurysmal wall. In the two other cases, chronic infection of C. burnetii was diagnosed by serologic examination after surgery for an abdominal aortic aneurysm. One patient with negative blood culture results had amaurosis fugax due to endocarditis and required aortic valve replacement; recurrent fever without evidence of valve dysfunction or infection developed in one patient who had had prosthetic cardiac valve replacement 6 months earlier for endocarditis. Aortic aneurysms were treated with in situ prosthetic grafts and long-term antibiotic therapy. At a mean follow-up of 12 years, no septic aortic complications occurred, and serologic test results have remained negative. The presence of an aortic aneurysm and cardiac valve disease seems to be a predisposing factor for chronic C. burnetii infection. Diagnosis particularly relies on the physician's awareness of this condition and is confirmed by serologic examination. Aortic aneurysm resection is mandatory to cure the chronic infection and must be associated with long-term antibiotic therapy.

Topics: Aged; Aneurysm, Infected; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Chronic Disease; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Iliac Artery; Male; Middle Aged; Q Fever; Rifampin

Endocarditis is a rare but life-threatening complication of brucellosis. Its mortality rate has recently been reduced with the use of combined medical and surgical treatment.. Between March 2002 and April 2004, 6 patients with Brucella endocarditis underwent surgery at the Siyami Ersek Cardiovascular Center in Istanbul, Turkey. The diagnosis of Brucellosis was based on the presence of clinical signs and symptoms compatible with brucellosis, serology and/or a positive blood culture. All patients with suspected Brucella endocarditis were studied by echocardiography. The diagnosis of Brucella endocarditis was made in accordance with Duke's criteria.. The most commonly affected valve was the aortic valve (4 patients). Four patients had prosthetic valves because of a previous history of rheumatic fever. In 5 patients, elective surgery was performed. Five patients underwent valve replacement with prosthetic valves, but 1 patient underwent excision of the abscess cavity without valve replacement. There was no operative mortality. All patients continued antibiotic treatment for at least 3 months postoperatively. The median duration of follow-up after surgery was 12 months. During the follow-up period, 1 patient died, while the others remained alive with no recurrences.. Prosthetic valve replacement is a safe procedure in patients with Brucella endocarditis. Surgical interventions combined with triple antibiotic therapy yield good results with no recurrence in the long-term follow-up.

Topics: Adult; Aged; Brucellosis; Combined Modality Therapy; Doxycycline; Endocarditis, Bacterial; Female; Humans; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of Corynebacterium striatum endocarditis that was treated successfully with daptomycin plus rifampin following an unsuccessful attempt at vancomycin desensitization and failure of linezolid therapy.. A 46-year-old woman with hemodialysis-dependent chronic renal failure was admitted for a graft-related infection. She presented with C. striatum endocarditis that was treated with daptomycin plus rifampin due to a history of allergies to vancomycin and beta-lactam antibiotics and failure of linezolid therapy. The patient received daptomycin and rifampin for a total of 6 weeks. Three months after completion of treatment, no recurrence of endocarditis was evident.. Daptomycin is a lipopeptide antibiotic, with rapid bactericidal activity. It has demonstrated efficacy in animal models of staphylococcal, streptococcal, and enterococcal endocarditis. Case reports of its activity in methicillin-resistant Staphylococcus aureus endocarditis have also been documented.. Daptomycin, which has shown in vitro activity against C. striatum, may be a viable treatment option for patients with C. striatum endocarditis who are either allergic or refractory to traditional antibiotics.

Topics: Anti-Bacterial Agents; Corynebacterium; Corynebacterium Infections; Daptomycin; Drug Administration Schedule; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Middle Aged; Rifampin; Treatment Outcome

Topics: Acetamides; Aged; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Linezolid; Male; Methicillin Resistance; Oxazolidinones; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Teicoplanin; Treatment Outcome; Tricuspid Valve

A 68-year old man with fever chills and a diastolic murmur was diagnosed with aortic-valve endocarditis caused by coagulase-negative Staphylococcus lugdunensis. The clinical condition initially improved with antibiotic therapy. On day seven, transoesophageal echocardiography revealed large abscesses extending from the aortic root to the left ventricular wall. Emergency cardiac surgery was performed successfully and a stentless bioprosthetic valve was inserted. S. lugdunensis endocarditis is known for its aggressive clinical course with valve destruction, abscess formation and embolic complications despite appropriate antibiotics. Antibiotic treatment alone is associated with a high mortality rate which can be reduced by early valve replacement.

Topics: Abscess; Aged; Aorta, Thoracic; Aortic Valve; Cefuroxime; Disease Progression; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Echocardiography; Echocardiography, Transesophageal; Endocarditis, Bacterial; Humans; Male; Microbial Sensitivity Tests; Pericardial Effusion; Rifampin; Staphylococcal Infections; Staphylococcus; Vancomycin

Brucellosis is a multisystemic disease. The most common cause of death from the disease is endocarditis. The aortic valve is most commonly affected. The disease rarely involves the mitral valve. A 30 year-old woman presented with complaints of chills and fever up to 38 degrees C at night, fatigue, palpitations, and dyspnea for the previous 3 weeks. Cardiac auscultation revealed a diastolic murmur in the mitral area. Her temperature was 38.3 degrees C. On echocardiographic examination, the mitral valve area was 0.62 cm (2) and an isoechoic mass thought to be a vegetation was detected on the anterior mitral leaflet. A diagnosis of infective endocarditis was made and vancomycin administration was commenced. Brucella melitensis was isolated in all three blood samples, however, the patient remained seronegative with Brucella agglutination titers of up to 1/160. The antibiotic therapy was then shifted to doxycycline (200 mg/day), rifampicin (600 mg/day), and ciprofloxacin (1000 mg/day). After 30 days of treatment, surgery was performed for the severely stenotic mitral valve and to remove the vegetation. The operation was successful. The postoperative period was uneventful. On the follow-up she had no complaints. In cases with Brucella endocarditis, after diagnosis, antibiotic therapy must be started immediately and when the clinical condition improves, surgical intervention should be performed when indicated.

Topics: Adult; Brucella melitensis; Brucellosis; Ciprofloxacin; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Mitral Valve Stenosis; Rifampin

We report the case of a 36-year-old patient who experienced an isolated acute pulmonary homograft endocarditis two years after a Ross procedure for aortic valve infective endocarditis.

Topics: Adult; Ampicillin; Aortic Valve; Bioprosthesis; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Hepatitis C, Chronic; HIV Infections; Humans; Male; Methadone; Prosthesis-Related Infections; Pulmonary Valve; Rifampin; Substance Abuse, Intravenous; Transplantation, Autologous

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.

Topics: Acute Disease; Adult; Amoxicillin; Anti-Inflammatory Agents; Aortic Valve; Aortic Valve Insufficiency; Arthralgia; Bangladesh; Clarithromycin; Diagnosis, Differential; Diagnostic Errors; Drug Therapy, Combination; Emigration and Immigration; Endocarditis, Bacterial; England; Female; Fever; Gentamicins; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Penicillin G; Penicillin V; Pericarditis; Pharyngitis; Prednisone; Recurrence; Rheumatic Fever; Rheumatic Heart Disease; Rifampin; Unnecessary Procedures; Vancomycin

Topics: Actinobacillus Infections; Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Follow-Up Studies; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Male; Middle Aged; Pleural Effusion; Rifampin; Time Factors; Treatment Outcome

Topics: Adult; Anti-Infective Agents; Brucellosis; Doxycycline; Endocarditis, Bacterial; Humans; Male; Middle Aged; Rifampin; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin-resistant Staphylococcus aureus is becoming increasingly prevalent as both a nosocomial and a community-acquired pathogen. Daptomycin, a lipopeptide antibiotic now in phase III clinical trials, is rapidly bactericidal in vitro against a range of gram-positive organisms, including methicillin-resistant S. aureus (MRSA). In this study, we compared the efficacy of daptomycin with that of vancomycin, each with or without rifampin, in a model of experimental aortic valve endocarditis due to MRSA. The infecting strain (MRSA strain 32) was susceptible to daptomycin (MIC = 1 micro g/ml), vancomycin (MIC = 0.5 micro g/ml), and rifampin (MIC = 0.5 micro g/ml). Daptomycin was administered at 25 or 40 mg/kg q24h (q24h) by subcutaneous injection in an attempt to simulate human doses of 4 and 6 mg/kg q24h, respectively. Vancomycin was given at 150 mg/kg q24h by continuous intravenous infusion. Rifampin was given at 25 mg/kg by intramuscular injection q24h. Treatment was started 6 h postinoculation and continued for 4.5 days. Outcome was assessed by counting the residual viable bacteria in vegetations. The mean peak daptomycin levels in serum at 2 h after subcutaneous administration of 25 and 40 mg/kg were 64 and 91 micro g/ml, respectively. Daptomycin was undetectable in serum at 24 h. The total exposure was comparable to that achieved clinically in humans receiving the drug. Bacterial counts (mean log(10) number of CFU per gram +/- the standard deviation) in untreated controls reached 10.6 +/- 0.8. In treated rats, bacterial counts were as follows: vancomycin, 7.1 +/- 2.5; daptomycin at 25 mg/kg, 5.5 +/- 1.7; daptomycin at 40 mg/kg, 4.2 +/- 1.5. The difference between daptomycin at 40 mg/kg and vancomycin at 150 mg/kg was statistically significant (P = 0.004). In the study of combination therapy, vegetation bacterial counts were as follows: daptomycin at 40 mg/kg, 4.6 +/- 1.6; rifampin, 3.6 +/- 1.3; vancomycin plus rifampin, 3.3 +/- 1.1; daptomycin plus rifampin, 2.9 +/- 0.8. The difference between daptomycin and daptomycin plus rifampin was statistically significant (P = 0.006). These results support the continued evaluation of daptomycin for serious MRSA infections, including infective endocarditis.

Topics: Animals; Anti-Bacterial Agents; Daptomycin; Drug Therapy, Combination; Endocarditis, Bacterial; Male; Methicillin Resistance; Microbial Sensitivity Tests; Rats; Rats, Sprague-Dawley; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Topics: Aortic Valve; Bartonella henselae; Cat-Scratch Disease; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Diseases; Humans; Male; Middle Aged; Mitral Valve; Rifampin; Ultrasonography

The efficacy of linezolid, alone or in combination with rifampin, against methicillin-susceptible Staphylococcus aureus in rabbits with experimental endocarditis was investigated. Linezolid (50 or 75 mg/kg of body weight), rifampin, and linezolid (25, 50, or 75 mg/kg) plus rifampin produced statistically significant reductions in bacterial counts compared with those in untreated controls. Plasma or valvular vegetation levels of linezolid in the groups treated with the linezolid-rifampin combination were similar to those in the respective linezolid-only treatment groups. At therapeutic levels of linezolid, rifampin resistance was not observed. The results from this experimental model of endocarditis suggest that while rifampin did not provide synergy to the linezolid dosing, it did not antagonize the efficacy of linezolid.

Topics: Acetamides; Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Colony Count, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valves; Kidney; Linezolid; Male; Methicillin; Microbial Sensitivity Tests; Oxazolidinones; Penicillins; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Topics: Adult; Aortic Valve; Diagnosis, Differential; Drug Therapy, Combination; Dysarthria; Endocarditis, Bacterial; Facial Paralysis; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Oxacillin; Penicillins; Rifampin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Time Factors

The nondiphtheriae corynebacteria are uncommon but increasingly recognized as agents of endocarditis in patients with underlying structural heart disease or prosthetic-valves. We describe three cases of nosocomial endocarditis caused by nondiphtheriae corynebacteria, including the first reported case of Corynebacterium amycolatum, endocarditis. These all occurred in association with indwelling intravascular devices.

Topics: Aged; Catheters, Indwelling; Corynebacterium; Corynebacterium Infections; Cross Infection; Endocarditis, Bacterial; Fatal Outcome; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Prosthesis-Related Infections; Rifampin; Vancomycin

A 69-y-old woman with bioprosthetic endocarditis due to Listeria monocytogenes developed an allergic reaction after beginning ampicillin treatment. She was cured with the combination of trimethoprim-sulfamethoxazole, rifampicin and teicoplanin. No immune deficiency was found in the patient.

Topics: Aged; Anti-Bacterial Agents; Drug Hypersensitivity; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Listeria monocytogenes; Listeriosis; Penicillins; Prosthesis-Related Infections; Rifampin; Teicoplanin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Aortic Valve; Brucellosis; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Prosthesis-Related Infections; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Endocarditis, Bacterial; Humans; Male; Rifampin; Streptomycin

We evaluated the activities of quinupristin-dalfopristin (Q-D), alone or in combination with rifampin, against three strains of Staphylococcus aureus susceptible to rifampin (MIC, 0.06 microg/ml) and to Q-D (MICs, 0.5 to 1 microg/ml) but displaying various phenotypes of resistance to macrolide-lincosamide-streptogramin antibiotics: S. aureus HM1054 was susceptible to quinupristin and dalfopristin (MICs of 8 and 4 microg/ml, respectively); for S. aureus RP13, the MIC of dalfopristin was high (MICs of quinupristin and dalfopristin for strain RP13, 8 and 32 microg/ml, respectively); and S. aureus HM1054R was obtained after conjugative transfer of macrolide-lincosamide-streptogramin B constitutive resistance to HM1054, and the MIC of quinupristin for this strain was high (MICs of quinupristin and dalfopristin, 64 and 4 microg/ml, respectively). In vitro time-kill curve studies showed an additive effect [corrected] between Q-D and rifampin, at a concentration of four times the MIC, against the three strains. Rabbits with aortic endocarditis were treated 4 days with Q-D, rifampin, or their combination. In vivo, the combination was highly bactericidal and synergistic against strains susceptible to quinupristin (HM1054 and RP13) and sterilized 94% of the animals. In contrast, the combination was neither synergistic nor bactericidal against the quinupristin-resistant strain (HM1054R) and did not prevent the emergence of mutants resistant to rifampin. We conclude that the in vivo synergistic and bactericidal activity of the combination of Q-D and rifampin against S. aureus is predicted by the absence of resistance to quinupristin but not by in vitro combination studies.

Topics: Animals; Anti-Bacterial Agents; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Kinetics; Lincosamides; Macrolides; Microbial Sensitivity Tests; Mutation; Phenotype; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Virginiamycin

To report a case of pill-induced esophagitis caused by oral rifampin.. English-language references identified via a MEDLINE search from January 1966 to May 1998 and a bibliographic review of pertinent articles.. A large number of oral medications have been reported to cause pill-induced esophagitis. This case represents the second report attributed to rifampin. A 70-year-old white man receiving vancomycin, gentamicin, and oral rifampin for treatment of Staphylococcus epidermidis prosthetic valve endocarditis reported dysphagia immediately after swallowing a rifampin capsule on the fourth day of therapy. The following day, fiberoptic laryngoscopy and esophagoscopy demonstrated a red capsule partially embedded in the neopharynx. A day later, upper esophageal obstruction consistent with edema related to pill-induced esophagitis was identified by barium swallow. Following the procedure, the patient was placed on total parenteral nutrition and took nothing by mouth. Sixteen days after first reporting dysphagia, he was placed on a full liquid diet. Several factors may have increased the patient's risk for pill-induced esophagitis, including age, bedridden state, gastroesophageal reflux disease, simultaneous administration of several medications, and neopharyngeal stricture.. Oral rifampin may cause esophagitis. Healthcare providers should be alert to the possibility of pill-induced esophagitis in susceptible patients. Patients with predisposing factors for the development of pill-induced esophagitis should be educated about proper swallowing of oral medications.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Esophagitis; Heart Valve Prosthesis Implantation; Humans; Male; MEDLINE; Mitral Valve; Postoperative Complications; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Tablets

Topics: Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Ofloxacin; Rifampin

Topics: Aged; Doxycycline; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecium; Gram-Positive Bacterial Infections; Humans; Male; Rifampin; Vancomycin; Virginiamycin

Topics: Adult; Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Rifampin; Sterilization

A case of aortic valve endocarditis caused by Coxiella burnetii and operated on with success is reported. The patient is doing well at 18 months follow up. Diagnosis of Q-fever endocarditis was made by high antibodies against phase I Coxiella burnetii antigens titration and by demonstration of aortic valvular vegetations by bidimensional echocardiography. Our patient suffered emergency aortic valve substitution due to acute hemodynamic failure and started a long-term treatment with doxycycline and rifampicin. Some interesting aspects about the diagnosis and treatment of this patient are reviewed because long-term follow-up and serological controls are still rare in the literature.

Topics: Anti-Bacterial Agents; Aortic Valve; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; Q Fever; Rifampin; Time Factors

The Dacron sewing ring material of the St. Jude Medical mechanical heart valve (St. Jude Medical, Inc., St. Paul, Minn.) was passively impregnated with rifampicin (60 mg/ml) both in its unsealed state and after sealing by the methods of preclotting in blood, autoclaving in blood, and autoclaving in 20% albumin. Antistaphylococcal activity in the Dacron material was assessed immediately after rifampicin impregnation and at regular periods up to 5 days after implantation into the goat aorta. When the Dacron material had been sealed by autoclaving in blood and autoclaving in 20% albumin significant retention of antistaphylococcal activity was found after 5 days in vivo. Best results were obtained with the use of autoclaved blood (p < 0.05). We also compared these results with those obtained from impregnating commercially available gelatin-sealed (Gelseal) and collagen-sealed (Hemashield) Dacron material with rifampicin. Although antistaphylococcal activity was equivalent immediately after rifampicin impregnation, after 4 days in vivo the activity was negligible in Gelseal material (p < 0.05) and could not be demonstrated in Hemashield material. Rifampicin impregnation of the intact St. Jude Medical mechanical valve sewing ring may have an application in the prevention of prosthetic valve endocarditis and a clinical protocol is suggested.

Topics: Albumins; Animals; Anti-Bacterial Agents; Aortic Valve; Blood; Collagen; Drug Delivery Systems; Endocarditis, Bacterial; Female; Gelatin; Goats; Heart Valve Prosthesis; Polyethylene Terephthalates; Prosthesis Design; Rifampin; Staphylococcus aureus; Sterilization; Surface Properties; Time Factors

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve, and a fearful complication is the formation of aortic root abscess. Due to the characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are achieved in combination with surgery. We describe 2 cases of brucella endocarditis involving the aortic valve. Aggressive treatment, with surgery performed during a period of active infection, produced good results in eradication of infection and in preventing fatal complications such as rupture of aortic root abscesses.

Topics: Anti-Bacterial Agents; Aortic Valve; Brucellosis; Doxycycline; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Follow-Up Studies; Humans; Male; Middle Aged; Rifampin; Time Factors

A 71-year-old woman with active aortic prosthetic endocarditis due to Methicillin-resistant Staphylococcus epidermidis (MRSE) and subannular mycotic aneurysm and paravalvular leakage and acute mitral regurgitation underwent emergent surgical treatment. The mycotic aneurysm was closed using a prosthetic patch after surgical debridement. Re-aortic valve replacement with a 21-mm Hancock II prosthesis was performed at the paraannular position by utilizing the patch. Mitral valve was also replaced with a 27-mm Hancock II prosthesis. Antibiotic therapy was provided by vancomycin combined with rifampicin and gentamicin. The following regimen was given, vancomycin 1 g i.v. q12h for 6 weeks plus gentamicin 80 mg/day i.v. for 4 weeks plus rifampicin 450 mg/day orally for 6 weeks. Vancomycin and gentamicin doses were modified appropriately according to the monitored serum levels in the patient with renal failure. Postoperative course was uneventful. The patient is doing well 11 months after surgery and no recurrence of infection has been seen. We conclude that prompt surgical removal of the infected sources and appropriate antibiotic therapy based on the bacteriology may be the only curative treatment for uncontrolled infection at the active phase of MRSE prosthetic endocarditis.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Valve; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Macrolides; Methicillin Resistance; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Vancomycin

Topics: Ceftriaxone; Cephalosporin Resistance; Endocarditis, Bacterial; Female; Humans; Middle Aged; Penicillin Resistance; Penicillins; Rifampin; Streptococcus pneumoniae; Vancomycin

The efficacy of cefazolin or cefpirome alone or combined with rifampin was compared with that of vancomycin alone or combined with rifampin in an experimental model of methicillin-resistant, beta-lactamase-producing, coagulase-negative staphylococcal endocarditis. Phenotypically, the mecA gene-positive strain used in vivo did not exhibit methicillin resistance by the agar dilution or disk susceptibility method but was resistant in vitro (oxacillin MIC, 64 micrograms/ml) by the microtiter dilution method with 2% NaCl supplementation. Macrodilution broth susceptibilities of standard inocula failed to demonstrate cross-resistance of staphylococci to cefazolin (MIC, 8 micrograms/ml) or cefpirome (MIC, 4 micrograms/ml). In vivo, vancomycin and cefpirome had similar activities, and both regimens were more effective than was cefazolin alone. While the MIC of rifampin was low (0.031 micrograms/ml), monotherapy with rifampin resulted in a bimodal distribution of outcomes due to the expected emergence of resistant mutants. The results in vitro of time-kill synergy studies using rifampin in combination with cefazolin or cefpirome varied with the antimicrobial concentrations tested and did not reliably predict activities in vivo of rifampin-beta-lactam combination therapies. Cefpirome, but not cefazolin or vancomycin, in combination with rifampin was synergistic in vivo. Cefpirome in combination with rifampin was more effective than was cefazolin in combination with rifampin. Both cephalosporin-rifampin regimens were significantly more effective than was cephalosporin or vancomycin monotherapy and were as effective as vancomycin combined with rifampin. These data support further evaluation of rifampin-beta-lactam combinations as possible alternative therapies to vancomycin-containing regimens for selected methicillin-resistant coagulase-negative staphylococcal infections.

Topics: Animals; Antibiotics, Antitubercular; beta-Lactamases; Cephalosporins; Coagulase; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Methicillin Resistance; Microbial Sensitivity Tests; Phenotype; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Ampicillin or amoxicillin at 625-800 mg/kg/day, in combination with a beta-lactamase inhibitor, each is as effective as vancomycin in animal models of methicillin-resistant Staphylococcus aureus endocarditis. Studies were done to determine whether the addition of rifampin would permit lowering the dose of ampicillin into the range recommended for use in humans without loss of efficacy. The efficacy of ampicillin/sulbactam (300/150 or 150/75 mg/kg/day intramuscularly, in three divided doses) in combination with rifampin (5 mg/kg intramuscularly, three times daily) was compared with that of vancomycin (25 mg/kg intravenously, twice daily, or 30 mg/kg intramuscularly, three times daily) in the rabbit model of methicillin-resistant S. aureus aortic valve endocarditis. Neither ampicillin/sulbactam nor rifampin alone was effective. The ampicillin/sulbactam/rifampin regimen was as effective as vancomycin. This regimen may be an alternative to vancomycin in treatment of methicillin-resistant S. aureus infections.

Topics: Ampicillin; Animals; Aortic Valve; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Sulbactam; Vancomycin

Results of in vitro time-kill synergy studies using subinhibitory, inhibitory, or suprainhibitory concentrations of bactericidal agents were compared with treatment outcomes of experimental infective endocarditis due to a methicillin-susceptible strain of Staphylococcus aureus. For rifampin-cephalosporin combinations, in vitro synergy testing using recommended fractions of the MIC failed to predict antagonism in vivo while concentrations above the MIC corresponded with antagonism in vivo.

Topics: Animals; Cefazolin; Cefpirome; Cephalosporins; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Microbial Sensitivity Tests; Nafcillin; Predictive Value of Tests; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Time Factors

Topics: Acute Disease; Child; Cholecystectomy; Cholecystitis; Combined Modality Therapy; Endocarditis, Bacterial; Floxacillin; Gallbladder; Gentamicins; Humans; Male; Ornidazole; Parenteral Nutrition, Total; Rifampin; Staphylococcal Infections; Ultrasonography

Two patients with infectious endocarditis (IE) by Staphylococcus aureus resistant to methicillin, aminoglucosides and rifampicin (SARMAR) acquired in hospital during the course of an epidemic outbreak of this microorganism in the Hospital Clínic i Provincial of Barcelona. Both patients had undergone surgery of the lower limbs. The entrance of the microorganism was the infection of the surgical wound, with bacteriemia, followed by mitral IE after a short time interval (20 days). Despite adequate treatment with vancomycin both patients died. The culture of mitral vegetation was positive for SARMAR in one. Analysis of the chromosomic DNA of all the isolations from the patients was identical and coincided with that of the SARMAR strains isolated in the epidemic outbreak of the hospital. The current situation of IE by SARMAR is reviewed and the therapeutic implications commented upon suggesting that treatment of this entity should simultaneously include the administration of vancomycin and phosphomycin or cotrimoxazole, with surgery being considered if infection persists.

Topics: Aged; Aminoglycosides; Anti-Bacterial Agents; Cross Infection; DNA, Bacterial; Drug Resistance, Microbial; Endocarditis, Bacterial; Fatal Outcome; Female; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Mitral Valve; R Factors; Rifampin; Staphylococcal Infections; Staphylococcus aureus

We compared ciprofloxacin, rifampin, and gentamicin treatments, alone and in combination, for 5 days in the therapy of experimental aortic valve endocarditis in rats caused by a clinical isolate of vancomycin-resistant Enterococcus faecium. The MICs and MBCs of vancomycin, ciprofloxacin, rifampin, and gentamicin were 250 and > 1,000, 3.1 and 6.3, 0.098 and 1.6, and 12.5 and > 50 micrograms/ml, respectively. Infected rats were sacrificed after completing 5 days of therapy. Additional rats within each treatment group were followed for 5 days beyond the last dose of antibiotic therapy. Although survivals in the different groups were not significantly different after 5 days of therapy, survival was significantly better 5 days beyond the last dose of antibiotic therapy in rats treated with rifampin-containing regimens. The combination of ciprofloxacin and gentamicin was bactericidal in vitro and in vegetations from rats with enterococcal endocarditis. Rifampin alone was similarly bactericidal in vivo, but it was not significantly better than rifampin in combination with other antibiotics. Subpopulations resistant to rifampin, but not ciprofloxacin, were detected in the inoculum and in most vegetations during therapy. However, the combination of ciprofloxacin plus both gentamicin and rifampin reduced both the rifampin-susceptible and -resistant population in vegetations of 9 of 10 animals below the level of detection after 5 days of therapy. Nevertheless, a residual enterococcal population apparently remained in numbers of < 2 log10 CFU/g after 5 days of therapy, which resulted in relapse. Perhaps a longer course of therapy would have eliminated this residual population and improved efficacy.

Topics: Ampicillin Resistance; Animals; Ciprofloxacin; Disease Models, Animal; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Male; Microbial Sensitivity Tests; Rats; Rats, Sprague-Dawley; Rifampin; Vancomycin

Topics: Adult; Ciprofloxacin; Drug Resistance, Microbial; Endocarditis, Bacterial; Humans; Male; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Topics: Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Pefloxacin; Q Fever; Rifampin

Topics: Administration, Oral; Adult; Ciprofloxacin; Endocarditis, Bacterial; Female; Glycopeptides; Humans; Male; Rifampin; Staphylococcal Infections; Teicoplanin

Topics: Brucellosis; Endocarditis, Bacterial; Humans; Rifampin

We compared oral temafloxacin, a new fluoroquinolone agent, with vancomycin, each with and without rifampin, in the therapy of rats with aortic valve endocarditis caused by a clinical isolate of methicillin-resistant Staphylococcus aureus. The temafloxacin, vancomycin, and rifampin MICs and MBCs were 0.78 and 1.56, 1.56 and 3.13, and less than 0.024 and 0.78 microgram/ml, respectively. The animals were classified into the following six treatment groups: vancomycin (60 mg/kg) +/- rifampin (6 mg/kg) each intramuscularly every 12 h for 5 days; temafloxacin (100 mg/kg) orally +/- rifampin (6 mg/kg) intramuscularly every 12 h for 5 days; rifampin (6 mg/kg) intramuscularly every 12 h for 5 days; and untreated controls. All regimens with either vancomycin or temafloxacin resulted in improved survival over controls, but only temafloxacin regimens resulted in a significant reduction in bacterial counts in vegetations. These data support further investigation of the efficacy of temafloxacin in treating serious infections caused by methicillin-resistant S. aureus.

Topics: 4-Quinolones; Administration, Oral; Animals; Anti-Infective Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Fluoroquinolones; Male; Methicillin; Microbial Sensitivity Tests; Penicillin Resistance; Quinolones; Rats; Rats, Inbred Strains; Rifampin; Staphylococcal Infections; Vancomycin

A combination of ciprofloxacin (intravenous then oral) and oral rifampicin was tested in 14 intravenous drug users with right-sided Staphylococcus aureus endocarditis. All 10 patients who completed therapy were cured based on resolution of symptoms and negative blood cultures at 4 weeks post therapy.

Topics: Adult; Ciprofloxacin; Drug Administration Schedule; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Male; Pilot Projects; Rifampin; Staphylococcal Infections; Substance Abuse, Intravenous

Six cases of well-documented Brucella endocarditis are reported. All the patients gave a history of ingestion of raw milk and/or being in contact with sheep and/or camels during herding. The diagnosis was based in each case on a history of ingestion of raw milk, high titres of Brucella antibodies, a positive blood culture and echocardiography. A combination of tetracycline, rifampicin and streptomycin was found to be effective in eradicating the Brucella organism. Two cases required aortic valve replacement, and another two required replacement of both aortic and mitral valves. One case died before any surgical intervention could be performed and one patient did not require surgery. Although it was noted that the Brucella organism attacks mainly valves which are already damaged, it may also attack and infect normal valves.

Topics: Adolescent; Adult; Aortic Valve; Brucellosis; Endocarditis, Bacterial; Female; Humans; Male; Prognosis; Rifampin; Saudi Arabia; Tetracycline

The therapeutic activities of ciprofloxacin (25 mg/kg every 8 h), rifampin (10 mg/kg every 24 h), ciprofloxacin plus rifampin, and vancomycin (17.5 mg/kg every 6 h) were compared by using the rabbit model of Staphylococcus aureus endocarditis. Animals infected with one of two test strains (SA1199 or SA487) were randomized into treatment groups and received 6 days of therapy. For SA1199, ciprofloxacin plus rifampin was most effective at reducing vegetation bacterial counts. For SA487, ciprofloxacin plus rifampin was as effective as vancomycin but less effective than ciprofloxacin alone. Resistance to ciprofloxacin at 5- and 10-fold the MIC emerged in the test strain in 82 and 55%, respectively, of rabbits infected with SA1199 and receiving ciprofloxacin monotherapy. The combination of ciprofloxacin and rifampin decreased these frequencies to 60% (P = 0.27) and 10% (P = 0.04). No resistance to ciprofloxacin was found in rabbits infected with SA487. We conclude that ciprofloxacin and ciprofloxacin plus rifampin are as efficacious as vancomycin in this model and that combining rifampin with ciprofloxacin may decrease the frequency at which high-level resistance to ciprofloxacin emerges. However, with respect to improved efficacy, the combination of ciprofloxacin and rifampin is unpredictable and may be detrimental.

Topics: Animals; Ciprofloxacin; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Kidney; Male; Rabbits; Rifampin; Spleen; Staphylococcal Infections

Topics: Brucellosis; Doxycycline; Endocarditis, Bacterial; Humans; Male; Middle Aged; Rifampin

We report a case of Q fever endocarditis in a patient who presented with a slight pyrexia and acute cardiac failure due to aortic incompetence. The diagnosis was made by detecting high titres of serum IgG and IgA antibody against Coxiella burnetii phase I antigens and confirmed by demonstrating C. burnetii on the excised aortic valve using immunofluorescence and electron microscopy. Aortic valve replacement was followed by initially successful antibiotic treatment for 15 months. Reappearance of IgA anti-phase I antibodies 5 months later suggested continued presence of bacteria, although the patient's condition remained satisfactory. In endemic areas, such as rural southern France, Q fever endocarditis should be considered when there is evidence of acute heart valve damage but are few other features of infection.

Topics: Acute Disease; Adult; Animals; Antibodies, Bacterial; Cardiac Output, Low; Coxiella; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; France; Humans; Male; Q Fever; Rifampin; Rural Population; Sheep

Endocarditis caused by nutritionally deficient streptococci has a high bacteriologic and clinical failure rate, despite appropriate antimicrobial therapy. We investigated by time kill curve methodology nine clinical endocarditis isolates of nutritionally deficient streptococci to determine the in vitro efficacies of vancomycin and rifampin alone and in combination. The combination of vancomycin and rifampin demonstrated synergy and bactericidal activity in five of the strains. In one strain, this combination inhibited growth by greater than 2 log10 CFU/ml when compared to the growth control or either antibiotic alone, but it failed to be bactericidal. Indifference, defined as less than or equal to 2 log10 CFU per milliliter increase in killing of the combination compared to the next most active single agent, was demonstrated with the remaining three isolates. Changing the antibiotic concentrations in the time kill curve studies for these latter strains failed to demonstrate synergistic activity of the antibiotic combination. The vancomycin and rifampin combination may be a promising therapeutic modality for which in vivo correlation is indicated.

Topics: Drug Synergism; Endocarditis, Bacterial; Humans; Rifampin; Streptococcal Infections; Streptococcus; Time Factors; Vancomycin

Staphylococcus epidermidis is an infrequent cause of native valve endocarditis. We describe two cases associated with mitral valve prolapse, and discuss the significance, diagnosis and management of this condition.

Topics: Adult; Endocarditis, Bacterial; Floxacillin; Fusidic Acid; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Prolapse; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Vancomycin

Teicoplanin and rifampicin were evaluated as single and combined agents in the treatment of endocarditis due to Staphylococcus epidermidis in the rabbit model. Rabbits were treated for ten days and the number of bacteria in vegetations determined. At the end of ten days the geometric mean number of bacteria in the vegetations were 5.53 X 10(8), 6.68 X 10(6). 1.10 X 10(4), 2.57 X 10(1) cfu/g of vegetation for control, teicoplanin, rifampicin, and teicoplanin plus rifampicin groups respectively. The MIC and MBC values of the S. epidermidis isolates were 0.78 mg/l for teicoplanin and less than or equal to 0.10 mg/l for rifampicin. In the rifampicin treated group three post-treatment isolates of S. epidermidis tested exhibited marked resistance to rifampicin with MIC and MBC values greater than or equal to 200 mg/l. Teicoplanin and rifampicin were both effective as single agents in the clearance of S. epidermidis from the bloodstream. Rifampicin was more effective than teicoplanin in the clearance of S. epidermidis from vegetations but teicoplanin in combination with rifampicin was more effective than either drug alone.

Topics: Animals; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Glycopeptides; Male; Microbial Sensitivity Tests; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Teicoplanin

Topics: Ampicillin; Aortic Rupture; Aortic Valve; Echocardiography; Endocarditis, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Medical Illustration; Middle Aged; Necrosis; Rifampin; Suppuration

In rats challenged with viridans streptococci poorly susceptible to antibiotic killing, single doses of antibiotics only prevent endocarditis induced by bacterial inoculum sizes that produce disease in 90% of control animals (ID90): additional doses are required to protect against inocula exceeding the ID90. We investigated whether single-dose rifampin would extend the efficacy of single-dose prophylaxis to inocula exceeding the ID90. We used two strains of viridans streptococci highly susceptible to killing by rifampin and two resistant strains. All rats were injected with 10-1,000 times the ID90 of the four strains. Single-dose rifampin successfully prevented endocarditis due to all four strains. A few prophylaxis failures were observed after challenge with the two poorly susceptible strains, but in vivo emergence of resistant variants did not account for these failures. Thus, rifampin was the first antibiotic given as a single dose that successfully prevented experimental streptococcus endocarditis after challenge with high bacterial inocula.

Topics: Adhesiveness; Animals; Blood Platelets; Drug Resistance, Microbial; Endocarditis, Bacterial; Female; Microbial Sensitivity Tests; Rats; Rats, Inbred Strains; Rifampin; Streptococcal Infections; Streptococcus

Rifampin-induced thrombocytopenia has been recognized as an immunological reaction associated with intermittent high-dose therapy, and rarely seen with daily low-dose regimens. Our patient was a 33-year-old male with Marfan's syndrome who was given rifampin 600 mg/d po along with intravenous vancomycin for the treatment of Staphylococcus epidermidis endocarditis. His platelet count dropped from a baseline of 519,000/mm3 to 4000/mm3 after four doses of rifampin. Petechiae were present on the lower extremities without the presence of other bleeding sites. Rifampin, low-dose aspirin, and dipyridamole were discontinued. His platelet count returned to normal nine days after discontinuation of therapy. With the increasing use of rifampin for the treatment of nontuberculosis infections, clinicians should recognize the possibility of this drug causing such serious immunological reactions as thrombocytopenia, hemolytic anemia, acute renal failure, and shock with daily or intermittent therapy.

Topics: Adult; Endocarditis, Bacterial; Humans; Male; Rifampin; Staphylococcal Infections; Thrombocytopenia

We tested the ability of teicoplanin alone and in combination with rifampicin or gentamicin to cure experimental endocarditis and granuloma pouch infections in rats caused by Streptococcus faecalis, Str. sanguis, methicillin-sensitive and -resistant Staphylococcus aureus. Vancomycin and ampicillin were also tested. Teicoplanin was more active than vancomycin and ampicillin. Combinations of teicoplanin with rifampicin or gentamicin were significantly more effective than single drug therapy. These results suggest that teicoplanin could be an interesting alternative to vancomycin in the treatment of serious streptococcal and staphylococcal infections in man.

Topics: Animals; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Glycopeptides; Granuloma; Male; Methicillin; Penicillin Resistance; Rats; Rats, Inbred F344; Rifampin; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Teicoplanin; Vancomycin

This study compared teicoplanin with vancomycin without and with gentamicin and/or rifampin for treatment of experimental endocarditis due to methicillin-resistant Staphylococcus epidermidis. In rabbits treated for three days and killed 12 hr after the last doses of antimicrobial agents, no significant difference in reducing bacterial titers of vegetations was detected between vancomycin and teicoplanin without and with gentamicin and/or rifampin. Addition of gentamicin and/or rifampin to vancomycin or teicoplanin significantly reduced bacterial titers of vegetations compared with vancomycin or teicoplanin alone. Addition of rifampin alone or gentamicin plus rifampin was significantly more effective than addition of gentamicin alone. In rabbits treated for three days and killed seven days after the last doses of antimicrobial agents, no significant difference in sterilizing vegetations was detected between vancomycin and teicoplanin with gentamicin and/or rifampin. However, there was a trend (probably due to the longer elimination half-life of teicoplanin in serum) that clearly favored teicoplanin over vancomycin. Teicoplanin plus rifampin without or with gentamicin is at least as effective as vancomycin plus rifampin without or with gentamicin for treatment of experimental endocarditis due to methicillin-resistant S. epidermidis.

Topics: Animals; Endocarditis, Bacterial; Female; Gentamicins; Glycopeptides; Methicillin; Microbial Sensitivity Tests; Penicillin Resistance; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Teicoplanin; Vancomycin

Topics: Aortic Valve; Aortic Valve Stenosis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Time Factors; Vancomycin

Two cases of endocarditis due to Lactobacillus plantarum and Lactobacillus casei var. rhamnosus are described. Both patients were successfully treated medically. The response of the two isolates to a range of concentrations of penicillin in an apparatus which continuously monitored growth is reported. The strain of L. casei var. rhamnosus was found to be penicillin tolerant. The use of a combination of a penicillin with gentamicin to treat endocarditis due to penicillin tolerant strains of lactobacillus is discussed. The criteria for selecting oral agents to follow intravenous therapy are assessed also.

Topics: Adult; Amoxicillin; Drug Therapy, Combination; Drug Tolerance; Endocarditis, Bacterial; Gentamicins; Humans; Lacticaseibacillus casei; Lactobacillus; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Penicillins; Rifampin

Two patients with prosthetic valve endocarditis due to methicillin-resistant Gram-positive cocci (Staphylococcus epidermidis and Micrococcus spp.) are described. They were successfully treated with rifampicin combined first with an aminoglycoside and later with co-trimoxazole or co-trimoxazole plus vancomycin. The addition of rifampicin to these antibiotics resulted in enhanced serum bactericidal activity. High doses of rifampicin (1200-1800 mg) for 7-8 weeks did not cause any serious side-effect. Surgery was not required. During surveillance for more than 2 years endocarditis did not recur.

Topics: Adult; Aminoglycosides; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Methicillin; Microbial Sensitivity Tests; Micrococcus; Middle Aged; Penicillin Resistance; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Studies of in vitro and in vivo bactericidal interactions of vancomycin plus rifampin against Staphylococcus aureus have yielded conflicting results. In this study the efficacy of this drug combination in experimental endocarditis due to a methicillin-resistant strain of S. aureus was investigated. Left-sided endocarditis was induced in 84 rabbits by an infecting strain that had been found to be synergistically killed by vancomycin plus rifampin in vitro when tested by the timed-kill curve technique; in contrast, the checkerboard technique had indicated that the two drugs were antagonistic against this strain. Infected animals received no therapy, vancomycin alone (30 mg/kg per day), rifampin alone (20 mg/kg per day), or both drugs (in the same doses). The combination was significantly more effective than the single-drug regimens in terms of (1) reduction of mean methicillin-resistant S. aureus vegetation titers (P less than .05-.0005), (2) rate and incidence of sterilization of vegetations (P less than .0005), and (3) rate of "radical" cure of endocarditis (P less than .005). Vancomycin alone and vancomycin plus rifampin were equally effective in reducing mortality and sterilizing renal abscesses. The use of vancomycin prevented the in vivo development of resistance to rifampin. No evidence that rifampin exerted an antagonistic effect on the in vivo bactericidal activity of vancomycin was found.

Topics: Animals; Creatinine; Disease Models, Animal; Drug Therapy, Combination; Endocarditis, Bacterial; Kidney; Methicillin; Microbial Sensitivity Tests; Penicillin Resistance; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Development of rifampin-resistant Staphylococcus epidermidis was documented in three patients receiving vancomycin and rifampin therapy for prosthetic valve endocarditis. The minimum inhibitory concentrations and minimum bactericidal concentrations of rifampin for the original three isolates were 0.4 micrograms/mL or less. Organisms cultured during relapse or prosthetic valve replacement had minimum inhibitory concentrations of rifampin that were 12.5, 50, and greater than 100 micrograms/mL, respectively. Surgical intervention was necessary in all patients. One died, and one required a second prosthetic valve placement. The patients were treated with vancomycin plus aminoglycoside following identification of rifampin resistance. These observations suggest that vancomycin and rifampin may not be adequate therapy for prosthetic valve endocarditis caused by S epidermidis.

Topics: Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Reoperation; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Tobramycin; Vancomycin

Topics: Adult; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Oxacillin; Rifampin; Staphylococcal Infections

Staphylococcal endocarditis is a condition affecting intravenous drug abusers at increasing rates, and its treatment is still controversial. We used, successfully, high doses of rifampicin, associated with an aminoglycoside, for the treatment of two heroin addicts. In the first we found a left-sided endocarditis with metastatic abscesses in brain, both kidneys, liver and spleen; in the other the finding of bilateral lung abscesses was related to embolic episodes from a diseased tricuspid valve. Since the isolated strains of Staphylococcus aureus were tolerant to methicillin, we used oral rifampicin (20 mg/kg/day) plus an aminoglycoside (amikacin in the former and gentamicin in the latter), after in-vitro testing had proved these combinations to be effective. We achieved, in both cases stable bactericidal concentrations in the serum and a lasting clinical recovery.

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heroin Dependence; Humans; Methicillin; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections

Actinobacillus actinomycetemcomitans is a gram-negative coccobacillus which is a very rare cause of bacterial endocarditis. Preexisting cardiac lesions are a main contributing factor, and antibiotic prophylaxis has long been felt necessary before dental or other manipulation to prevent endocarditis. Penicillin in combination with an aminoglycoside has been the most often used treatment regimen. We present a case of endocarditis caused by this organism which developed after antibiotic prophylaxis for dental cleaning. Streptomycin and rifampin therapy resulted in the cure of the infection. The treatment and epidemiology of Actinobacillus endocarditis are reviewed.

Topics: Actinobacillus Infections; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Middle Aged; Rifampin; Streptomycin

In-vitro synergy testing was performed against ten blood or valve isolates of Staphylococcus epidermidis taken from patients with endocarditis. A three-dimensional microtitre checkerboard method was used for evaluation of vancomycin-rifampicin-gentamicin. The triple combination of vancomycin plus rifampicin plus gentamicin was found to be synergistic in 70% of the isolates. Vancomycin plus rifampicin was not synergistic. Oral agents including dicloxacillin, rifampicin, and fusidic acid were also evaluated. Four methicillin-resistant isolates were relatively resistant to dicloxacillin (MIC greater than 0.79 mg/l) but all four isolates were susceptible to fusidic acid alone and rifampicin alone. The triple combination of dicloxacillin plus fusidic acid plus rifampicin was found to be synergistic in 50% of the isolates and generally superior to any two-drug combination raising the possibility of an effective oral combination of antibiotics.

Topics: Anti-Bacterial Agents; Dicloxacillin; Drug Combinations; Drug Synergism; Endocarditis, Bacterial; Fusidic Acid; Gentamicins; Humans; Microbial Sensitivity Tests; Rifampin; Staphylococcus epidermidis; Vancomycin

Prosthetic valve endocarditis due to Legionella pneumophila occurred in a woman who had aortic and mitral valve replacements with porcine xenografts. During surgery for persistent fever and aortic regurgitation due to presumed endocarditis, she had vegetations involving both the aortic and mitral valve prostheses with a circumferential abscess of the aortic annulus. Cultures, Dieterle stain, and direct fluorescent antibody stain of valve tissue, and subsequent measurements of serum antibody levels confirmed L. pneumophila as the infecting organism. This infection occurred in the absence of pneumonia. Legionella pneumophila must be considered a potential cause of culture-negative prosthetic valve endocarditis and should be sought in appropriate clinical circumstances.

Topics: Aortic Valve; Bacterial Infections; Bioprosthesis; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Female; Heart Valve Prosthesis; Humans; Legionella; Middle Aged; Mitral Valve; Rifampin

10 patients with serious infections caused by Staphylococcus epidermidis (8 cases of endocarditis in non-prosthetic valves, 1 was complicated by osteomyelitis, 1 case of osteomyelitis, and 1 case of septicemia) are described. Clinical and microbiologic features were evaluated including antibiotic sensitivity and synergy studies, phage typing and biotyping. Endocarditis tended to affect the elderly population and the clinical manifestations were quite similar to those caused by Streptococcus viridans. Both patients with osteomyelitis had involvement of the cervical spine with excellent response to antibiotic therapy. The only patient with septicemia acquired via hyperalimentation had delayed clearance of the bacteremia but ultimately responded to intravenous antibiotics. Rifampicin was the most effective of all antibiotics tested. All isolates were sensitive to penicillinase-resistant penicillins and cephalosporins and over half were sensitive to penicillin. Full synergistic activity was demonstrated with cephalothin and nafcillin in combination with rifampicin, and rifampicin-vancomycin was partially synergistic against the majority of the strains. Five of 8 available isolates were non-phage typeable and no definite pattern was established for various types of infections. Four of the 8 isolates were classified as biotype SIIa, 2 biotype SIIc and 2 biotype SVh.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteriological Techniques; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Osteomyelitis; Rifampin; Sepsis; Staphylococcal Infections; Staphylococcus epidermidis

Topics: Adult; Endocarditis, Bacterial; Female; Humans; Rifampin; Shock, Septic; Staphylococcal Infections; Syndrome

Optimal antimicrobial therapy for viridans streptococcal endocarditis remains controversial. Rifampin was bactericidal at less than 0.2 micrograms/ml for ten strains of viridans streptococci isolated from patients with endocarditis. Administration of rifampin to one endocarditis patient already receiving penicillin and gentamicin increased the serum bactericidal activity fourfold. Rifampin has been effective in combination therapy for serious staphylococcal and enterococcal infections. The combination of penicillin and rifampin may be an effective, less toxic alternative to penicillin and streptomycin for the treatment of viridans streptococcal endocarditis.

Topics: Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; In Vitro Techniques; Penicillins; Rifampin; Streptococcus

Topics: Aged; Endocarditis, Bacterial; Humans; Male; Methicillin; Penicillin Resistance; Rifampin; Staphylococcal Infections; Vancomycin

Topics: Adult; Drug Combinations; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Q Fever; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

An eight-year-old boy developed staphylococcal endocarditis. He was treated initially with nafcillin and gentamicin, but he remained febrile. The minimum bactericidal concentration (MBC) of nafcillin was 130 times the minimum inhibitory concentration (MIC). Following the addition of rifampin to the antibiotic regimen, the patient became afebrile and recovered. The discrepancy between the MBC and MIC indicated tolerance to nafcillin. Tolerance is a mode of antibiotic resistance that must be considered in treating life-threatening illness.

Topics: Child; Drug Tolerance; Endocarditis, Bacterial; Humans; Male; Nafcillin; Rifampin; Staphylococcal Infections

Topics: Cephalexin; Cephalothin; Clindamycin; Cloxacillin; Endocarditis, Bacterial; Gentamicins; Humans; Male; Middle Aged; Rifampin; Staphylococcal Infections

Topics: Adult; Aortic Valve; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Postoperative Complications; Pseudomonas Infections; Rifampin; Tobramycin

A subinhibitory concentration of rifampin converted a strain of Escherichia coli from serum resistant to serum susceptible. When continually cultured in nutrient broth containing 1.5 microgram of rifampin per ml, this strain of E. coli became susceptible to killing by both normal human serum and normal rabbit serum. Copared to the original strain, the rifampin-treated E. coli displayed no detectable change in adherence capability, but appeared less virulent in the rabbit model of endocarditis. A rifampin-resistant mutant of the E. coli strain was not found to undergo conversion to serum susceptibility upon culture in rifampin.

Topics: Animals; Aortic Valve; Blood Bactericidal Activity; Dogs; Endocarditis, Bacterial; Escherichia coli; Humans; Rabbits; Rifampin

Staphylococcus epidermidis endocarditis occurred four days following aortic valve replacement with a Björk-Shiley prosthesis. Antimicrobial therapy, shown to be effective by in vitro and in vivo studies, failed to eradicate the infection. When rifampin was added to the existing antibiotic regimen, peak serum bactericidal activity increased, the patient defervesced, and blood cultures became negative.

Topics: Adult; Aortic Valve; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Postoperative Complications; Rifampin; Staphylococcal Infections

Topics: Adult; Endocarditis, Bacterial; Humans; Male; Psittacosis; Rifampin

Antibiotic prophylaxis for the prevention of endocarditis due to methicillin-resistant Staphylococcus epidermidis (MRSE) was evaluated in a modified rabbit endocarditis model and compared with results obtained with methicillin-sensitive S. epidermidis (MSSE). One dose of nafcillin, cefamandole, cephalothin, or vancomycin neither prevented endocarditis nor sterilized the blood of rabbits challenged with each of two MRSE or two MSSE isolates. One dose of gentamicin protected greater than or equal to 80% of animals challenged with three of the four isolates, and one dose of rifampin protected greater than or equal to 90% challenged with any of the four isolates. Multiple doses of any of the antibiotics prevented endocarditis in greater than or equal to 80% of rabbits challenged with MSSE, and four doses of vancomycin protected rabbits challenged with MRSE. However, MRSE endocarditis was prevented in less than or equal to 25% of animals given six doses of nafcillin or cephalosporins. Thus, nafcillin and cephalosporins were ineffective prophylaxis for MRSE endocarditis, whereas vancomycin, gentamicin, and rifampin were effective.

Topics: Animals; Anti-Bacterial Agents; Cefamandole; Cephalothin; Endocarditis, Bacterial; Female; Gentamicins; Male; Methicillin; Nafcillin; Penicillin Resistance; Rabbits; Rifampin; Staphylococcal Infections; Staphylococcus; Vancomycin

Two children with persistent bacteremia and endocarditis due to Staphylococcus aureus failed to respond to vancomycin therapy, even though serum levels greatly exceeded the inhibitory concentrations. The Staphylococcus from one patient was resistant to methicillin; the other patient had a penicillin hypersensitivity. There was a wide disparity between the minimum inhibitory and the minimum bactericidal concentrations of vancomycin. Striking clinical and laboratory evidence of improvement was demonstrated with the addition of rifampin therapy.

Topics: Blood; Child, Preschool; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Infant; Male; Methicillin; Penicillin Resistance; Rifampin; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Three patients with bacterial endocarditis (one case due to Staphylococcus aureus and two to S epidermidis) failed to improve on standard therapeutic regimens which were judged adequate by in vitro testing for sensitivity. Rifampin was added to the regimen in each case and resulted in increased bactericidal activity in the serum, sterilization of the cardiac valves, and clinical cure. The apparent clinical success that was achieved suggests that further investigation of the effectiveness of therapy with rifampin in selected cases of staphylococcal endocarditis is warranted.

Topics: Adult; Endocarditis, Bacterial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Oxacillin; Rifampin; Staphylococcal Infections; Vancomycin

A patient prviously suspected of having a mycobacterial infection was found to have a Mycobacterium gordonae infection of his prosthetic aortic valve. Following replacement of his infected prosthesis and systemic therapy for two years, the patient has apparently been cured.

Topics: Aortic Valve; Endocarditis, Bacterial; Ethambutol; Heart Valve Prosthesis; Humans; Isoniazid; Male; Middle Aged; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Rifampin

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood reamined sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.

Topics: Adult; Aortic Valve Insufficiency; Brucellosis; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Rifampin; Streptomycin; Tetracycline

Rifampin was added to existing antibiotic regimens in two patients with Staphylococcus epidermidis infections; one patient had prosthetic valve endocarditis and the other had an infection of a CSF shunt. The addition of rifampin increased serum or CSF bactericidal titers 16-fold or greater and was correlated with a favorable clinical response. The results of tests for tube-dilution antibiotic susceptibility showed rifampin to be the most active of all antibiotics tested against the patients' organisms. The combinations of gentamicin sulfate, nafcillin sodium, or vancomycin hydrochloride with rifampin prevented the emergence of rifampin resistance in vitro and promoted enhanced killing when compared with either antibiotic alone.

Topics: Adolescent; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Drug Synergism; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Nafcillin; Postoperative Complications; Rifampin; Staphylococcal Infections; Staphylococcus; Vancomycin

The rate at which various antimicrobial agents eradicated Staphylococcus aureus from cardiac vegetations in a rabbit model of endocarditis was studied. The rate at which various drugs and combinations killed high titers of bacteria in broth correlated with the relative effectiveness of the agents in vivo. Gentamicin plus penicillin proved to be synergistic in vitro and more effective in eradicating bacteria from cardiac vegetations in vivo than was penicillin alone. Vancomycin killed bacteria at a rate similar to that for the combination of penicillin and gentamicin, and the rate for cefazolin was similar to that for penicillin alone. Clindamycin was less effective in vivo and in vitro than penicillin. Therapy with rifampin led to the emergence of resistant organisms, and, when penicillin, this drug was less effective in vitro and in vivo than was penicillin alone. This model appears to offer an effective method for evaluation of antimicrobial treatment of staphylococcal endocarditis.

Topics: Animals; Anti-Bacterial Agents; Cephalothin; Clindamycin; Disease Models, Animal; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Penicillins; Rabbits; Rifampin; Staphylococcal Infections; Time Factors; Vancomycin

The effectiveness of various antibiotics commonly recommended for the prophylaxis of bacterial endocarditis has been evaluated in experimental streptococcal endocarditis in rabbits. High doses of penicillin G did not prevent the development of this infection. The only consistently successful prophylactic regimens using penicillin alone were those which provided for both an early high serum level and more than 9 h of effective antimicrobial action. Vancomycin was the only other drug which proved uniformly successful when given alone, even though the duration of its antimicrobial action in the blood was only 3 h. However, combined therapy using penicillin G or ampicillin with streptomycin was always effective in prophylaxis. Treatment with single injections of ampicillin, cephaloridine, cephalexin, clindamycin, cotrimoxazole, rifampicin, streptomycin, erythromycin, and tetracycline failed to prevent infection. The findings provide information on the effect of antimicrobials in vivo and may be applicable to the chemoprophylaxis of infective endocarditis in clinical practice.

Topics: Ampicillin; Animals; Cephaloridine; Clindamycin; Endocarditis, Bacterial; Erythromycin; Female; Male; Penicillin G; Rabbits; Rifampin; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Bacteria; Bacteroides; Bacteroides Infections; Chloramphenicol; Embolism; Endocarditis, Bacterial; Erythromycin; Humans; Lincomycin; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Rifampin; Tetracycline; Vancomycin

Topics: Administration, Oral; Child; Endocarditis, Bacterial; Erythromycin; Humans; Male; Rifampin; Staphylococcal Infections

Topics: Child, Preschool; Endocarditis, Bacterial; Erythromycin; Humans; Male; Microbial Sensitivity Tests; Rifampin

Topics: Adult; Aged; Bronchiectasis; Bronchitis; Chronic Disease; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Osteomyelitis; Rifampin

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Endocarditis, Bacterial; Erythromycin; Female; Fusidic Acid; Humans; Infant; Infant, Newborn; Male; Methicillin; Middle Aged; Novobiocin; Penicillin Resistance; Pneumonia, Staphylococcal; Rifampin; Sepsis; Staphylococcal Infections